Healthcare Provider Details

I. General information

NPI: 1326097189
Provider Name (Legal Business Name): HEATHER ANN HAUKNESS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 CHICAGO AVE
OAK PARK IL
60302
US

IV. Provider business mailing address

260 CHICAGO AVE
OAK PARK IL
60302
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-8070
  • Fax: 708-383-0811
Mailing address:
  • Phone: 708-383-8070
  • Fax: 708-383-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: