Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036135078 | IL |
Y | 111NI0900X | Internist | 036135078 | IL |
N | 207R00000X | Internist | 125-059287 | IL |
N | 111NI0900X | Internist | 125-059287 | IL |
NPI | 1003100629 |
---|---|
Provider Name | Diane Marie Heidmann |
First Address | Chicago, IL 60611-2987 |
Second Address | Chicago, IL 60611-2987 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2011 |
Last Update Date | 12/05/2016 |