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General NPI Number Information
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NPI Number | 1700196391
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Entity Type | Individual
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Provider Name | STANLEY JAY HELLER MD
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Gender | Male
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 150 S WACKER DRIVE SUITE 2600
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City | CHICAGO
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State | IL
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Zip | 60606
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Country | US
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Telephone | 312-346-8700
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Fax | 312-346-5180
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Provider Business Mailing Address
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Address Line | 150 S WACKER DRIVE SUITE 2600
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City | CHICAGO
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State | IL
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Zip | 60606
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Country | US
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Telephone | 312-346-8700
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Fax | 312-346-5180
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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 | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number | 036-040665
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License Number State | IL
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