Provider Demographics
NPI:1548262520
Name:JARECKI, HEIDI LEANNE (MD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LEANNE
Last Name:JARECKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2715 DAMON ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3899
Mailing Address - Country:US
Mailing Address - Phone:715-834-8471
Mailing Address - Fax:715-834-8964
Practice Address - Street 1:2715 DAMON ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2634
Practice Address - Country:US
Practice Address - Phone:715-834-8471
Practice Address - Fax:715-834-0373
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45527-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3465850Medicaid
WIP00251212Medicare PIN
WI3465850Medicaid