Provider Demographics
NPI:1831160647
Name:MCKELLAR, HEIDI LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LOUISE
Last Name:MCKELLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:LOUISE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7208
Mailing Address - Country:US
Mailing Address - Phone:214-645-8525
Mailing Address - Fax:
Practice Address - Street 1:2201 INWOOD RD 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-1806
Practice Address - Country:US
Practice Address - Phone:214-645-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8740207RH0002X, 2085R0001X, 2085H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085H0002XAllopathic & Osteopathic PhysiciansRadiologyHospice and Palliative Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0007363100OtherAETNA
TX148500501Medicaid
920006629OtherRR MEDICARE
TX83271GOtherBCBS
TX83271GOtherBCBS
G93900Medicare UPIN