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NPI Code Detail

MEDICARE: HEARTLAND HEALTH OUTREACH

MEDICARE: HEARTLAND HEALTH OUTREACH
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
11223G0001XGeneral Practice Dentistry017IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1103326OTHERILDORAL DENTAL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447417118
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEARTLAND HEALTH OUTREACH
Provider Business Mailing Address
First Line : 4750 N SHERIDAN RD
Second Line : SUITE 434
City : CHICAGO
State : IL
Zip : 60640-7528
Country : US
Telephone Number : 773-751-1704
Fax Number : 773-751-4175
Provider Business Practice Location Address
First Line : 2418 W DIVISION ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-2940
Country : US
Telephone Number : 773-252-6413
Fax Number : 773-252-6417
Authorized Official
Title or Position : CONTROLLER
Name : HEIDI NELSON
Credential :
Telephone Number : 773-751-4107
Provider Enumeration Date : 05/20/2008
Last Update Date : 05/20/2008

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Directions to “HEARTLAND HEALTH OUTREACH ” Practice Location

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