MEDICARE: DR. HEATHER B HEIBERGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	036103613	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053330720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER B HEIBERGER M.D.

Provider Business Mailing Address
First Line	:	959 S WAUKEGAN RD
Second Line	:	FLOOR 2
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2654
Country	:	US
Telephone Number	:	847-234-3250
Fax Number	:	847-234-8155

Provider Business Practice Location Address
First Line	:	959 S WAUKEGAN RD
Second Line	:	FLOOR 2
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2654
Country	:	US
Telephone Number	:	847-234-3250
Fax Number	:	847-234-8155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	02/19/2015

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