Provider Demographics
NPI:1902891963
Name:HEIMERMAN, MARK (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:HEIMERMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 SW 6TH AVE. SUITE 200
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615
Mailing Address - Country:US
Mailing Address - Phone:785-233-7491
Mailing Address - Fax:785-233-2564
Practice Address - Street 1:6001 SW 6TH AVE. SUITE 200
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615
Practice Address - Country:US
Practice Address - Phone:785-233-7491
Practice Address - Fax:785-233-2564
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100340740AMedicaid
KSR32057Medicare UPIN