MEDICARE: SCOTT HEINRICH 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	207P00000X	Emergency Medicine Physician	036119625	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	:	1538340856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT HEINRICH M.D.

Provider Business Mailing Address
First Line	:	1750 W HARRISON ST
Second Line	:	SUITE 108 KELLOGG
City	:	CHICAGO
State	:	IL
Zip	:	60612-3825
Country	:	US
Telephone Number	:	312-942-5110
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 W HARRISON ST
Second Line	:	SUITE 108 KELLOGG
City	:	CHICAGO
State	:	IL
Zip	:	60612-3825
Country	:	US
Telephone Number	:	312-942-5110
Fax Number	:

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

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	10/28/2016

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Directions to “ SCOTT HEINRICH M.D.” Practice Location

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