=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649219460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD W HEINRICHS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2006
-----------------------------------------------------
Last Update Date | 08/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 BROTHER GEENEN WAY
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34236-7102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-556-3220
-----------------------------------------------------
Fax | 941-955-8214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1720 HIGHWAY 59 S
-----------------------------------------------------
City | THIEF RIVER FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56701-4331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-681-4747
-----------------------------------------------------
Fax | 218-683-2595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 20734
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------