Provider Demographics
NPI:1053330720
Name:HEIBERGER, HEATHER B (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:B
Last Name:HEIBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 S WAUKEGAN RD
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2654
Mailing Address - Country:US
Mailing Address - Phone:847-234-3250
Mailing Address - Fax:847-234-8155
Practice Address - Street 1:959 S WAUKEGAN RD
Practice Address - Street 2:FLOOR 2
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2654
Practice Address - Country:US
Practice Address - Phone:847-234-3250
Practice Address - Fax:847-234-8155
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103613207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103613Medicaid
ILL91185Medicare ID - Type Unspecified
IL036103613Medicaid