Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 036155266 | IL |
N | 2086X0206X | Surgical Oncologist | L6422 | TX |
NPI | 1235220955 |
---|---|
Provider Name | Amy B. Heimberger |
First Address | Chicago, IL 60611-5970 |
Second Address | Chicago, IL 60611-5970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 03/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152169201 | (05) | TX |
H65715 | (02) |