Provider Demographics
NPI:1326001256
Name:HEIL, THOMAS LUKE (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LUKE
Last Name:HEIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 DYER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1905
Mailing Address - Country:US
Mailing Address - Phone:704-377-5772
Mailing Address - Fax:
Practice Address - Street 1:4364 HERITAGE TRACE PKWY # 112A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9106
Practice Address - Country:US
Practice Address - Phone:817-576-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0453207L00000X, 208VP0014X
SC27449208VP0014X
NC200000452208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAA7485A309OtherMEDICARE UPIN
TX89126P7Medicaid
TXNC1837AOtherMEDICARE UPIN
TXN00453Medicaid
TX2280704OtherMEDICARE UPIN
SCAA7485A309Medicare PIN
NCF90105Medicare UPIN
SCN00453Medicaid