Provider Demographics
NPI:1164543062
Name:HEATHER N.MCCOMBS, DPM, LLC
Entity Type:Organization
Organization Name:HEATHER N.MCCOMBS, DPM, LLC
Other - Org Name:HEATHER N.MCCOMBS, DPM, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:MCCOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:312-944-2929
Mailing Address - Street 1:845 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 930E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2252
Mailing Address - Country:US
Mailing Address - Phone:312-944-2929
Mailing Address - Fax:312-638-0834
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:SUITE 930E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-944-2929
Practice Address - Fax:312-638-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID
IL208748Medicare ID - Type Unspecified
IL208747Medicare ID - Type Unspecified
U82537Medicare UPIN