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General NPI Number Information
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NPI Number | 1891711743
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Entity Type | Individual
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Provider Name | KENNETH HEINRICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 3249 OAK PARK AVE
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City | BERWYN
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State | IL
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Zip | 60402-3429
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Country | US
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Telephone | 708-783-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 75 REMITT DRIVE LOCKBOX 3274
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City | CHICAGO
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State | IL
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Zip | 60675-3274
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Country | US
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Telephone | 866-916-5259
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Fax | 231-922-4030
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 38590
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2009010649
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036-110486
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4845120
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35.093955
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0101248860
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License Number State | VA
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Taxonomy #7
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 46549
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License Number State | TN
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Taxonomy #8
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301094015
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License Number State | MI
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