MEDICARE: DR. THOMAS A HEGGEN MD

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	036074991	IL
2	207R00000X	Internal Medicine Physician	036074991	IL
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	036074991	IL
4	208600000X	Surgery Physician	036074991	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	:	1710974860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS A HEGGEN MD

Provider Business Mailing Address
First Line	:	1548 STATION PARK DR
Second Line	:
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-2719
Country	:	US
Telephone Number	:	847-850-5882
Fax Number	:	847-850-5892

Provider Business Practice Location Address
First Line	:	1300 BUSCH PKWY
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-4505
Country	:	US
Telephone Number	:	847-850-5882
Fax Number	:	845-850-5892

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	03/30/2015

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