MEDICARE: COLLEEN ANN HENIFF 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	207Q00000X	Family Medicine Physician	036091536	IL

General Provider Information

NPI Number	:	1972509594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN ANN HENIFF M.D.

Provider Business Mailing Address
First Line	:	2850 W 95TH ST
Second Line	:	SUITE 205
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2735
Country	:	US
Telephone Number	:	708-499-2070
Fax Number	:	708-229-6072

Provider Business Practice Location Address
First Line	:	2850 W 95TH ST
Second Line	:	SUITE 205
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2735
Country	:	US
Telephone Number	:	708-499-2070
Fax Number	:	708-229-6072

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	06/18/2014

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