Healthcare Provider Details

I. General information

NPI: 1215399167
Provider Name (Legal Business Name): DR HEINLENS HEALTH CARE CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2016
Last Update Date: 11/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N STATE ST SUITE B
STANTON MI
48888-9708
US

IV. Provider business mailing address

PO BOX 136
TROUT LAKE MI
49793-0136
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-0898
  • Fax: 616-459-6963
Mailing address:
  • Phone: 989-304-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101015385
License Number StateMI

VIII. Authorized Official

Name: DR. LENE ANNETTE HEINLEN
Title or Position: OWNER
Credential: D.O.
Phone: 989-304-1343