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General NPI Number Information
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NPI Number | 1306811385
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Entity Type | Individual
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Provider Name | KENNETH S HEIFERMAN MD
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 7973 CHICAGO AVE
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City | RIVER FOREST
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State | IL
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Zip | 60305-1363
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Country | US
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Telephone | 708-209-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 7973 CHICAGO AVE
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City | RIVER FOREST
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State | IL
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Zip | 60305-1363
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Country | US
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Telephone | 708-209-1111
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 036067100
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License Number State | IL
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