Healthcare Provider Details

I. General information

NPI: 1083790760
Provider Name (Legal Business Name): ALICIA MARIE HEIDENREICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA MARIE ONDREJECH PA

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # A-10
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # A-10
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-4859
  • Fax: 216-445-1654
Mailing address:
  • Phone: 216-444-4859
  • Fax: 216-445-1654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.155890
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50-002512
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: