Glen Joseph Heinzl, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22801 Issued in WI

Practice address

2000 Progress Drive
New Lisbon, WI 53950-2000

Phone

(608) 562-6400

Fax

(608) 562-7382

NPI assigned

Jan 23, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356495444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N11015 19TH AVE.",
            "address_2": "P.O. BOX 499",
            "city": "NECEDAH",
            "state": "WI",
            "postal_code": "54646",
            "telephone_number": "608-565-7771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 PROGRESS DRIVE",
            "city": "NEW LISBON",
            "state": "WI",
            "postal_code": "539502000",
            "telephone_number": "608-562-6400",
            "fax_number": "608-562-7382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINZL",
        "first_name": "GLEN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "22801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grady Emily Dedrick, LPC, SAC-IT, CCAT
• Anne B. Fenwick, PA
• Daniel Carl Frye, LMFT
• Abigail Geis, MS ED.
• Grace Counseling & Family Services S.C
• Holly Helmann, M.A. IN COUNSELING
• Robin Hemerley, RDH
• Timothy R. Hinton, M.D.
• Robert F Hobday, D.D.S.
• Kathy Lynn Holly-Bixby, BA

• Family Medicine Physician in New Lisbon, WI
• Providers in New Lisbon, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.