MEDICARE: DR. THOMAS LUKE HEIL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	Q0453	TX
2	208VP0014X	Interventional Pain Medicine Physician	Q0453	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA7485A309	OTHER	TX	MEDICARE UPIN
3	NC1837A	OTHER	TX	MEDICARE UPIN
5	2280704	OTHER	TX	MEDICARE UPIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326001256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS LUKE HEIL MD

Provider Business Mailing Address
First Line	:	2817 DYER ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-1905
Country	:	US
Telephone Number	:	704-377-5772
Fax Number	:

Provider Business Practice Location Address
First Line	:	4364 HERITAGE TRACE PKWY # 112A
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9106
Country	:	US
Telephone Number	:	817-576-0884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	02/17/2020

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Directions to “ DR. THOMAS LUKE HEIL MD” Practice Location

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