Provider Demographics
NPI:1922027507
Name:HECKMAN, MICHAEL MERL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MERL
Last Name:HECKMAN
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 1:9502 HUEBNER RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1649
Mailing Address - Country:US
Mailing Address - Phone:210-558-4600
Mailing Address - Fax:210-558-4605
Practice Address - Street 1:9502 HUEBNER RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1649
Practice Address - Country:US
Practice Address - Phone:210-558-4600
Practice Address - Fax:210-558-4605
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5160174400000X, 207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110228704Medicaid
TXG5160OtherTEXAS LICENSE NUMBER
TXG5160OtherTEXAS LICENSE NUMBER
TXG5160OtherTEXAS LICENSE NUMBER
TXBH1293593OtherDEA REGISTRATION NUMBER