Individual
MICHAEL J HECIMOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3161 L ST, SACRAMENTO, CA 95816-5234
(916) 453-9999
(916) 739-1099
Mailing address
10470 OLD PLACERVILLE RD, ST 100, SACRAMENTO, CA 95827-2539
(800) 470-0070
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5101012044
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3056306115
BCBS PIN #
MI
01
—
310D460020
BCBS GROUP PIN
MI
05
—
4247427
—
MI
05
—
4247436
—
MI
01
—
CA3518
MEDICARE RR GROUP PIN
MI
Enumeration date
07/11/2006
Last updated
05/11/2015
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