Provider Demographics
NPI:1205917184
Name:HEILMAN, STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:HEILMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 N IH 35
Mailing Address - Street 2:ATTN: REIMBURSEMENT DEPT
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-2304
Mailing Address - Country:US
Mailing Address - Phone:512-708-3100
Mailing Address - Fax:
Practice Address - Street 1:4110 GUADALUPE ST
Practice Address - Street 2:ATTN: REIMBURSEMENT DEPT
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4223
Practice Address - Country:US
Practice Address - Phone:512-419-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0970208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP0837Y4358Medicaid
TX83Y435Medicare ID - Type Unspecified
TXP0837Y4358Medicaid