Healthcare Provider Details

I. General information

NPI: 1255395737
Provider Name (Legal Business Name): JUDITH HEILMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 W 25TH AVE STE 102
GARY IN
46404-3544
US

IV. Provider business mailing address

120 W 22ND ST STE 200
OAK BROOK IL
60523-1563
US

V. Phone/Fax

Practice location:
  • Phone: 219-884-2011
  • Fax: 219-844-0211
Mailing address:
  • Phone: 630-575-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71000992A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: