MEDICARE: DR. HEIDI LOUISE MCKELLAR 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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	J8740	TX
2	2085R0001X	Radiation Oncology Physician	J8740	TX
3	2085H0002X	Hospice and Palliative Medicine (Radiology) Physician	J8740	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	920006629	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0007363100	OTHER		AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	83271G	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1831160647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI LOUISE MCKELLAR MD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7208
Country	:	US
Telephone Number	:	214-645-8525
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 INWOOD RD 2ND FLOOR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-1806
Country	:	US
Telephone Number	:	214-645-4673
Fax Number	:

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	03/02/2020

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Directions to “ DR. HEIDI LOUISE MCKELLAR MD” Practice Location

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