Healthcare Provider Details

I. General information

NPI: 1144752932
Provider Name (Legal Business Name): HEEPKE JOHANNA KNICKEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEEPKE JOHANNA WENDROTH

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE. ML11013
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE. ML11013
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7179
  • Fax: 513-636-8929
Mailing address:
  • Phone: 513-636-7179
  • Fax: 513-636-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.142524
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: