Basic Information
| Provider Information | |||||||||
| NPI: | 1881673440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEIN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 E 6TH AVE | ||||||||
| Address2: | STE 1B | ||||||||
| City: | WINFIELD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671563144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168582610 | ||||||||
| FaxNumber: | 3168582793 | ||||||||
| Practice Location | |||||||||
| Address1: | 2610 N WOODLAWN BLVD | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672202729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168582610 | ||||||||
| FaxNumber: | 3168582793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 03/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-23682 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 04-23682 | KS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100145840G | 05 | KS | MEDICAID | 100145840J | 05 | KS | MEDICAID | 100145840K | 05 | KS | MEDICAID | P00606964 | 01 | KS | PALMETTO (RR MC) | OTHER | 100145840B | 05 | KS | MEDICAID |