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NPI Code Detail

MEDICARE: FREDERICK WILLIAM HEINEMAN MD

MEDICARE: FREDERICK WILLIAM HEINEMAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RH0002XHospice and Palliative Medicine (Internal Medicine) Physician35.127503OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3041017OTHERMEANTHEM

General Provider Information

NPI Number : 1568455954
Entity Type Code : Individual
Provider Name (Legal Business Name) : FREDERICK WILLIAM HEINEMAN MD
Provider Business Mailing Address
First Line : 17876 ST. CLAIR AVE.
Second Line :
City : CLEVELAND
State : OH
Zip : 44110
Country : US
Telephone Number : 800-707-8922
Fax Number :
Provider Business Practice Location Address
First Line : 17876 SAINT CLAIR AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44110-2602
Country : US
Telephone Number : 800-707-8922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 01/26/2016

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