Janice B Heikenen, MD
Individual provider Active NPI Pediatric Gastroenterology Physician · Mohawk, MI
NPI 1215037569 · NPPES record last updated Nov 15, 2013
Key facts
- NPI
- 1215037569
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Gastroenterology Physician 2080P0206X
- License
- 32580 (WI)
- Practice address
- 6287 Lagoon Lane
Box 439
Mohawk, MI 49950 - Phone
- (906) 289-4316
- NPI assigned
- Sep 25, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301089369 | MI | MD | Pediatric Gastroenterology Physician |
| 32580 | WI | MD | Pediatric Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iron County Community Hospitals Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Gastroenterology Physician | 2080P0206X | 32580 | WI | Yes |
| Pediatric Gastroenterology Physician | 2080P0206X | 4301089369 | MI |
Addresses
Primary practice location
6287 Lagoon Lane
Box 439
Mohawk, MI 49950
Mailing address
6287 Lagoon Lane
Box 439
Mohawk, MI 49950-0439
Phone (906) 289-4316
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 700C610000 | Other | MI | BCBS OF MI |
| 5345324 | Medicaid | MI | |
| 31957600 | Medicaid | WI |
Other providers in Mohawk, MI
All providers in Mohawk, MI · Pediatric Gastroenterology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.