Healthcare Provider Details

I. General information

NPI: 1598729212
Provider Name (Legal Business Name): JOHN P HEINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 LAKE MENDOTA DR
MADISON WI
53705-1471
US

IV. Provider business mailing address

3434 LAKE MENDOTA DR
MADISON WI
53705-1471
US

V. Phone/Fax

Practice location:
  • Phone: 608-238-2812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number28237
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: