Healthcare Provider Details

I. General information

NPI: 1720014095
Provider Name (Legal Business Name): JOHANNES HEYNS MB CHB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 SW FIRST AMERICAN PL
TOPEKA KS
66604-4059
US

IV. Provider business mailing address

1303 SW FIRST AMERICAN PL
TOPEKA KS
66604-4059
US

V. Phone/Fax

Practice location:
  • Phone: 785-234-2306
  • Fax: 785-234-2550
Mailing address:
  • Phone: 785-234-2306
  • Fax: 785-234-2550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number04-28690
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21991
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: