Provider Demographics
NPI:1437137239
Name:HEITHOFF, BRAD E (MD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:E
Last Name:HEITHOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-643-2516
Mailing Address - Fax:319-643-5720
Practice Address - Street 1:206 COOKSON DR
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:IA
Practice Address - Zip Code:52358-9632
Practice Address - Country:US
Practice Address - Phone:319-643-2516
Practice Address - Fax:319-643-5720
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-35993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00244984OtherRR MEDICARE
IA0460980Medicaid
IAI04360Medicare UPIN
IAI5478Medicare PIN