Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036091139 | IL |
NPI | 1013913573 |
---|---|
Provider Name | Dr. Michael J Hejna |
First Address | Riverside, IL 60546-2082 |
Second Address | Riverside, IL 60546-2082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01633451 | BLUE CROSS BLUE SHIELD (01) | IL |
036091139 | (05) | IL |
123175300 | US DEPARTMENT OF LABOR (01) | IL |
G35833 | (02) | IL |
P00075953 | RAILROAD MEDICARE (01) | IL |