Individual
DR. KEVIN A HEINTZELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1200 N STATE ST, SUITE 480, JACKSON, MS 39202-2001
(601) 352-2273
(601) 714-3415
Mailing address
PO BOX 23996, JACKSON, MS 39225
(601) 206-6100
(601) 206-6052
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20864
MS
207R00000X
Internal Medicine Physician
224633
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02272493
—
NY
05
—
03658704
—
MS
Enumeration date
11/01/2006
Last updated
06/06/2013
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