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General NPI Number Information
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NPI Number | 1417198839
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Entity Type | Individual
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Provider Name | JEANNETTE A HEIDLBERG M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/13/2009
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 9555 UPLAND LN N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4485
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Country | US
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Telephone | 952-993-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 54935
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 54935
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License Number State | MN
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