Healthcare Provider Details

I. General information

NPI: 1396720983
Provider Name (Legal Business Name): THOMAS HEISCHMIDT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N MERCHANT ST
EFFINGHAM IL
62401-2128
US

IV. Provider business mailing address

PO BOX 665
EFFINGHAM IL
62401-0665
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-7000
  • Fax:
Mailing address:
  • Phone: 217-342-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036097905
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036097905
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: