Healthcare Provider Details

I. General information

NPI: 1831456805
Provider Name (Legal Business Name): LOANN MAI HEURING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 CENTRAL PARK VILLAGE DR STE 200
EAGAN MN
55121-7707
US

IV. Provider business mailing address

3305 CENTRAL PARK VILLAGE DR
EAGAN MN
55121-7707
US

V. Phone/Fax

Practice location:
  • Phone: 952-826-6500
  • Fax:
Mailing address:
  • Phone: 651-406-8860
  • Fax: 651-406-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number62820
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number000
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number62820
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: