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General NPI Number Information
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NPI Number | 1215101316
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Entity Type | Individual
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Provider Name | MICHAEL HEFFERLY MA
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Gender | Male
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 1855 W TAYLOR ST RM B46
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City | CHICAGO
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State | IL
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Zip | 60612-7242
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Country | US
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Telephone | 312-996-1518
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Fax |
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Provider Business Mailing Address
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Address Line | 1855 W TAYLOR ST RM B46
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City | CHICAGO
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State | IL
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Zip | 60612-7242
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Country | US
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Telephone | 312-996-1518
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State | IL
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