Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A112234 | CA |
Y | 207PP0204X | Pediatric Emergency Physician | 036.132589 | IL |
NPI | 1134387269 |
---|---|
Provider Name | Dr. Benjamin Reis Heilbrunn |
First Address | Chicago, IL 60637 |
Second Address | Chicago, IL 60637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 10/06/2014 |