Provider Demographics
NPI:1174589691
Name:HEIDGEN, DEBRA L (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:HEIDGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-2807
Mailing Address - Country:US
Mailing Address - Phone:816-599-5500
Mailing Address - Fax:
Practice Address - Street 1:1001 6TH AVE STE 210
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3248
Practice Address - Country:US
Practice Address - Phone:913-682-3920
Practice Address - Fax:913-682-6239
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-18860208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS017823Medicare PIN
F04020Medicare UPIN