Healthcare Provider Details

I. General information

NPI: 1922533454
Provider Name (Legal Business Name): SAMANTHA LEE HEYWOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA LEE SCHMIDT

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12251 S 80TH AVE
PALOS HEIGHTS IL
60463-1290
US

IV. Provider business mailing address

12251 S 80TH AVE
PALOS HEIGHTS IL
60463-1290
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-4000
  • Fax: 708-923-4816
Mailing address:
  • Phone: 708-923-4000
  • Fax: 708-923-4816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036161167
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: