Provider Demographics
NPI:1164634689
Name:HECKLER, MATTHEW W (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:W
Last Name:HECKLER
Suffix:
Gender:M
Credentials:DO
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:PO BOX 713130
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-0001
Mailing Address - Country:US
Mailing Address - Phone:937-415-9100
Mailing Address - Fax:937-415-9191
Practice Address - Street 1:7677 YANKEE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3475
Practice Address - Country:US
Practice Address - Phone:937-428-0400
Practice Address - Fax:937-415-9191
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9585207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3046448Medicaid
OHP00871995OtherRR MEDICARE
OHHE4262111Medicare PIN