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General NPI Number Information
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NPI Number | 1407948607
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Entity Type | Individual
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Provider Name | ANDREW JON HERITCH MD
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 5901 N PROSPECT RD STE 201A
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City | PEORIA
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State | IL
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Zip | 61614-4346
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Country | US
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Telephone | 630-428-7890
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Fax | 630-428-7891
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Provider Business Mailing Address
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Address Line | 4800 N SCOTTSDALE RD STE 2500
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7630
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Country | US
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Telephone |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036-104460
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License Number State | IL
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