Healthcare Provider Details

I. General information

NPI: 1467702480
Provider Name (Legal Business Name): JENNIFER HEIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 UNIVERSITY AVE W STE 160
SAINT PAUL MN
55114-1271
US

IV. Provider business mailing address

393 E WALNUT ST
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-3500
  • Fax:
Mailing address:
  • Phone: 816-444-6888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number49219
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number73068
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: