Healthcare Provider Details

I. General information

NPI: 1235220955
Provider Name (Legal Business Name): AMY B. HEIMBERGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 20-100
CHICAGO IL
60611-5970
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 20-100
CHICAGO IL
60611-5970
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8143
  • Fax: 312-695-4430
Mailing address:
  • Phone: 312-695-8143
  • Fax: 312-695-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036155266
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberL6422
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: