Individual
AMANDA HEIDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2630 HIGHWAY K, O FALLON, MO 63368-6624
(636) 980-5300
(636) 980-5344
Mailing address
670 MASON RIDGE CENTER DR, SUITE 300, SAINT LOUIS, MO 63141-8573
(636) 980-5300
(636) 980-5344
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2002002039
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043329105
—
MO
Enumeration date
08/30/2006
Last updated
02/20/2012
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