Provider Demographics
NPI:1811973324
Name:HECKMAN-DAVIS, CYNTHIA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LEE
Last Name:HECKMAN-DAVIS
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 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:601 N. MICHIGAN ST.
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:IN
Practice Address - Zip Code:46536
Practice Address - Country:US
Practice Address - Phone:574-784-8244
Practice Address - Fax:574-784-8632
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033081A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000391881OtherBCBS BMG IRELAND
IN080018191OtherRR MEDICARE
IN000000085185OtherBCBS BMG LAKEVILLE
IN100089660Medicaid
IN000000085185OtherBCBS BMG LAKEVILLE
IN100089660Medicaid
IND95429Medicare UPIN
IN167490GMedicare PIN