Provider Demographics
NPI:1629068697
Name:HELLER, KIMBERLY K (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:HELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9647 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1735
Mailing Address - Country:US
Mailing Address - Phone:210-735-5225
Mailing Address - Fax:210-735-3207
Practice Address - Street 1:9647 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1735
Practice Address - Country:US
Practice Address - Phone:210-735-5225
Practice Address - Fax:210-735-3207
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121528701Medicaid
B23423Medicare UPIN
TX121528701Medicaid