Healthcare Provider Details

I. General information

NPI: 1851195788
Provider Name (Legal Business Name): HEATHER HAGOPIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

V. Phone/Fax

Practice location:
  • Phone: 708-304-9700
  • Fax: 773-296-3020
Mailing address:
  • Phone: 708-304-9700
  • Fax: 773-296-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number125.086755
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: