Provider Demographics
NPI:1699979518
Name:HECKER, TRAVIS M (MD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:M
Last Name:HECKER
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 1:36500 AURORA DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4899
Mailing Address - Country:US
Mailing Address - Phone:262-434-5000
Mailing Address - Fax:262-434-5350
Practice Address - Street 1:36500 AURORA DR
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:WI
Practice Address - Zip Code:53066-4899
Practice Address - Country:US
Practice Address - Phone:262-434-5000
Practice Address - Fax:262-434-5350
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01387207L00000X, 207LP2900X
WI2537207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCP693DOtherMEDICARE PTAN
WI1699979518Medicaid
NCNCP693BOtherMEDICARE PTAN
NCNCP693COtherMEDICARE PTAN
NCNCP693EOtherMEDICARE PTAN
WIK400380202OtherMEDICARE