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NPI Code Detail

MEDICARE: GREGORY THOMAS HEINEN MD

MEDICARE:   GREGORY THOMAS HEINEN  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
1207X00000XOrthopaedic Surgery PhysicianG081061CA
2207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianG81061CA

Other Identifiers

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

General Provider Information

NPI Number : 1962447961
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY THOMAS HEINEN MD
Provider Business Mailing Address
First Line : 301W HUNTINGTON DR 617
Second Line :
City : ARCADIA
State : CA
Zip : 91007-1518
Country : US
Telephone Number : 626-574-9745
Fax Number : 626-574-8741
Provider Business Practice Location Address
First Line : 301W HUNTINGTON DR 617
Second Line :
City : ARCADIA
State : CA
Zip : 91007-1518
Country : US
Telephone Number : 626-574-9745
Fax Number : 626-574-8741
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2006
Last Update Date : 06/27/2024

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