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General NPI Number Information
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NPI Number | 1558462531
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Entity Type | Individual
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Provider Name | KURT P HEINKING D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 26520 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1265
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Country | US
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Telephone | 630-743-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 LACEY RD
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5430
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Country | US
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Telephone | 630-743-4500
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036093294
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036093294
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 036.093294
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 036.093294
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License Number State | IL
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