Healthcare Provider Details

I. General information

NPI: 1619656832
Provider Name (Legal Business Name): HEART OF HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4947 N WINTHROP MEDICAL CENTER FLR 1
CHICAGO IL
60640
US

IV. Provider business mailing address

7709 NILES CENTER RD
SKOKIE IL
60077-2768
US

V. Phone/Fax

Practice location:
  • Phone: 773-455-4325
  • Fax: 773-838-0902
Mailing address:
  • Phone: 773-455-4325
  • Fax: 773-838-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACK M PHAM
Title or Position: PRESIDENT
Credential: DNP, APRNFPA, FNP-BC
Phone: 773-455-4325