Provider Demographics
NPI:1417946484
Name:HEIBEL, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:HEIBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7701 PRESERVE LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4473
Mailing Address - Country:US
Mailing Address - Phone:402-488-6969
Mailing Address - Fax:402-488-6911
Practice Address - Street 1:7701 PRESERVE LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4473
Practice Address - Country:US
Practice Address - Phone:402-488-6969
Practice Address - Fax:402-488-6911
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18056207N00000X, 207NI0002X, 207NS0135X, 207ND0900X, 207ND0101X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39203650100Medicaid
NE070016194OtherPALMETTO-RAILROAD MEDICAR
NE35672OtherBLUE CROSS BLUE SHIELD
NE070016194OtherPALMETTO-RAILROAD MEDICAR
NE35672OtherBLUE CROSS BLUE SHIELD