Provider Demographics
NPI:1023473709
Name:GREGORY T. HEINEN, M.D., INC
Entity type:Organization
Organization Name:GREGORY T. HEINEN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-574-9745
Mailing Address - Street 1:301 W HUNTINGTON DR
Mailing Address - Street 2:SUITE 617
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3462
Mailing Address - Country:US
Mailing Address - Phone:626-574-9745
Mailing Address - Fax:
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:SUITE 617
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-574-9745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75817ZMedicaid