Healthcare Provider Details

I. General information

NPI: 1093451429
Provider Name (Legal Business Name): ERIC ANTHONY HEIDELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD # MS 4032
KANSAS CITY KS
66160-5389
US

IV. Provider business mailing address

3901 RAINBOW BLVD # MS 4032
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1847
  • Fax: 913-945-5062
Mailing address:
  • Phone: 913-588-1847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: