Healthcare Provider Details

I. General information

NPI: 1740449677
Provider Name (Legal Business Name): JONATHAN NEAL HEIMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59101 AMBER STREET CHILDREN'S INTERNATIONAL, LLC
SLIDELL LA
70461-2865
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 958-646-1580
  • Fax:
Mailing address:
  • Phone: 225-765-5727
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.204204
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: