Healthcare Provider Details

I. General information

NPI: 1215922067
Provider Name (Legal Business Name): RICHARD JAY HEHMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 MEMORIAL DR STE 280
BELLEVILLE IL
62226-5372
US

IV. Provider business mailing address

4550 MEMORIAL DR STE 280
BELLEVILLE IL
62226-5372
US

V. Phone/Fax

Practice location:
  • Phone: 618-767-3235
  • Fax:
Mailing address:
  • Phone: 618-767-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036084532
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: