Healthcare Provider Details

I. General information

NPI: 1568455954
Provider Name (Legal Business Name): FREDERICK WILLIAM HEINEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17876 SAINT CLAIR AVE
CLEVELAND OH
44110-2602
US

IV. Provider business mailing address

17876 ST. CLAIR AVE.
CLEVELAND OH
44110
US

V. Phone/Fax

Practice location:
  • Phone: 800-707-8922
  • Fax:
Mailing address:
  • Phone: 800-707-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number35.127503
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: