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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 Dentistry014IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1103349OTHERILDORAL DENTAL

General Provider Information

NPI Number : 1881860245
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 :
Provider Business Practice Location Address
First Line : 845 W WILSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5704
Country : US
Telephone Number : 773-728-7264
Fax Number :
Authorized Official
Title or Position : CONTROLLER
Name : HEIDI NELSON
Credential :
Telephone Number : 773-751-4107
Provider Enumeration Date : 05/06/2008
Last Update Date : 07/21/2022

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Directions to “HEARTLAND HEALTH OUTREACH ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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