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General NPI Number Information
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NPI Number | 1215037569
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Entity Type | Individual
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Provider Name | JANICE B HEIKENEN MD
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 6287 LAGOON LANE BOX 439
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City | MOHAWK
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State | MI
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Zip | 49950
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Country | US
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Telephone | 906-289-4316
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Fax |
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Provider Business Mailing Address
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Address Line | 6287 LAGOON LANE BOX 439
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City | MOHAWK
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State | MI
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Zip | 49950-0439
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Country | US
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Telephone | 906-289-4316
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 32580
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 4301089369
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License Number State | MI
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