Individual
JOHN ROBERT HECKENLIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 WALL ST, ANN ARBOR, MI 48105-1912
(734) 764-4190
Mailing address
3621 S STATE, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301082763
MI
207W00000X
Ophthalmology Physician
G27232
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G272320
MEDICAL PPIN #
CA
05
—
4572506
—
MI
Enumeration date
07/25/2006
Last updated
03/21/2012
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