Provider Demographics
NPI:1881693604
Name:HEINZ, TAD REEVE (MD)
Entity type:Individual
Prefix:DR
First Name:TAD
Middle Name:REEVE
Last Name:HEINZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2960 N CIRCLE DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1163
Mailing Address - Country:US
Mailing Address - Phone:719-578-1112
Mailing Address - Fax:719-578-0128
Practice Address - Street 1:2960 N CIRCLE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1163
Practice Address - Country:US
Practice Address - Phone:719-578-1112
Practice Address - Fax:719-578-0128
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO378012086S0122X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07551371Medicaid
COC40591Medicare ID - Type Unspecified
CO07551371Medicaid