Healthcare Provider Details

I. General information

NPI: 1407792492
Provider Name (Legal Business Name): EVAN HEINER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W BOWERY ST
AKRON OH
44308-1046
US

IV. Provider business mailing address

5455 GOLFWAY LN
LYNDHURST OH
44124-3739
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN.418116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: