Healthcare Provider Details

I. General information

NPI: 1649258484
Provider Name (Legal Business Name): DANIEL JOSEPH HEINTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 CLINCH AVENUE SOUTH TOWER 1ST FLOOR
KNOXVILLE TN
37916-3791
US

IV. Provider business mailing address

PO BOX 15004
KNOXVILLE TN
37901-5004
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-8481
  • Fax: 865-246-7560
Mailing address:
  • Phone: 865-541-8895
  • Fax: 865-633-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number55239
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: