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General NPI Number Information
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NPI Number | 1316278088
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Entity Type | Organization
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Legal Business Name | TIM HEILIZER SC CORP
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 2338 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60647-6541
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Country | US
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Telephone | 773-227-5914
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Fax |
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Provider Business Mailing Address
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Address Line | 1S376 SUMMIT AVE STE 4C
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-3966
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Country | US
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Telephone | 630-424-1122
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Fax | 630-324-0067
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Authorized Official
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Title or Position | REVENUE MANAGER
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Name | JAMES NOBLE
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Credential |
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Telephone | 630-424-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State |
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