Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036142788 | IL |
N | 111NI0900X | Internist | 036142788 | IL |
Y | 207RR0500X | Rheumatology | 036142788 | IL |
NPI | 1043639933 |
---|---|
Provider Name | Andrew Heisler |
First Address | Chicago, IL 60611-5966 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2014 |
Last Update Date | 03/09/2020 |