Basic Information
| Provider Information | |||||||||
| NPI: | 1669640892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEINZMAN | ||||||||
| FirstName: | KRISTOPHER | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 N IH 35 | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123248300 | ||||||||
| FaxNumber: | 5123248301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 38TH ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123243440 | ||||||||
| FaxNumber: | 5124066513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2008 | ||||||||
| LastUpdateDate: | 12/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | M3581 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0000X | M3581 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 284162906 | 05 | TX | MEDICAID | 284162903 | 05 | TX | MEDICAID | 284162901 | 05 | TX | MEDICAID | 8CY010 | 01 | TX | BCBS | OTHER | 8ET187 | 01 | TX | BCBS | OTHER | 284162902 | 05 | TX | MEDICAID | 284162907 | 05 | TX | MEDICAID | P01039889 | 01 | TX | RAILROAD MEDICARE | OTHER |