HERITAGE MEDICAL GROUP LTD NPI 1033121421

NPI Information

NPI: 1033121421
Provider Name: HERITAGE MEDICAL GROUP LTD
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
5660 W 95TH ST
SUITE 6
OAK LAWN, IL
ZIP 60453
Phone: (708) 499-3676
Get Directions

HERITAGE MEDICAL GROUP LTD is a specialist in Oak Lawn, IL. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. HERITAGE MEDICAL GROUP LTD NPI is 1033121421. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

5660 W 95TH ST
SUITE 6
OAK LAWN, IL
ZIP 60453-380
Phone: (708) 499-3676
Fax: (708) 499-1792

The provider's authorized official is Maria N Stavrakos .
The authorized official title is Office Manager and has the following contact phone number (708) 499-3676.

The enumeration date for this NPI number is 8/13/2006 and was last updated on 12/6/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1617593	OTHER	ILLINOIS	BLUECROSSBLUESHIELD
2	C41348	MEDICARE UPIN	ILLINOIS
3	CM1337	OTHER	ILLINOIS	MEDICARERR
4	458540	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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