Individual
MR. BRIAN J HEINEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
128 JACKSON STREET, BROOKLYN, IA 52211
(641) 522-7221
(641) 522-5816
Mailing address
PO BOX 527, 128 JACKSON STREET, BROOKLYN, IA 52211-0527
(641) 522-7221
(641) 522-5816
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
01662
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0415489
—
IA
01
—
06059
WELLMARK BLUE CROSS
IA
Enumeration date
10/18/2006
Last updated
11/20/2009
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