Provider Demographics
NPI:1871579409
Name:CRUZ, HELION W (MD)
Entity type:Individual
Prefix:
First Name:HELION
Middle Name:W
Last Name:CRUZ
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 1:353 NEW SHACKLE ISLAND RD.
Mailing Address - Street 2:SUITE 244C
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2380
Mailing Address - Country:US
Mailing Address - Phone:615-826-0442
Mailing Address - Fax:615-826-0447
Practice Address - Street 1:353 NEW SHACKLE ISLAND ROAD
Practice Address - Street 2:SUITE 244C
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2380
Practice Address - Country:US
Practice Address - Phone:615-826-0442
Practice Address - Fax:615-826-0447
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3857581Medicaid
TN3857581Medicare ID - Type Unspecified
TN3857581Medicaid