Healthcare Provider Details

I. General information

NPI: 1891796272
Provider Name (Legal Business Name): TIMOTHY A HEINRICHS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W MAIN ST SUITE 1
COLDWATER OH
45828-1773
US

IV. Provider business mailing address

116 W MAIN ST SUITE 1
COLDWATER OH
45828-1773
US

V. Phone/Fax

Practice location:
  • Phone: 419-763-5300
  • Fax: 419-763-5305
Mailing address:
  • Phone: 419-763-5300
  • Fax: 419-763-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35055465
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: