MEDICARE: JUDITH HEGGEN DO

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
1	2080P0203X	Pediatric Critical Care Medicine Physician	3455	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	13700	OTHER	IA	WELLMARK BLUE CROSS

General Provider Information

NPI Number	:	1891780730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH HEGGEN DO

Provider Business Mailing Address
First Line	:	PO BOX 4925
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50306-4925
Country	:	US
Telephone Number	:	515-246-9620
Fax Number	:	515-643-8316

Provider Business Practice Location Address
First Line	:	1111 6TH AVE
Second Line	:	MAIN 3
City	:	DES MOINES
State	:	IA
Zip	:	50314-2613
Country	:	US
Telephone Number	:	515-246-9620
Fax Number	:	515-643-8316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	05/26/2010

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