Provider Demographics
NPI:1124124441
Name:HECKMAN, AMILDA (DO)
Entity type:Individual
Prefix:
First Name:AMILDA
Middle Name:
Last Name:HECKMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-1272
Mailing Address - Country:US
Mailing Address - Phone:720-318-7014
Mailing Address - Fax:303-646-4342
Practice Address - Street 1:34061 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-7842
Practice Address - Country:US
Practice Address - Phone:303-646-4071
Practice Address - Fax:303-646-0908
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0129599-7Medicaid
CO0129599-7Medicaid
CO99904Medicare UPIN
COE85564HEMedicare UPIN