Provider Demographics
NPI:1235220955
Name:HEIMBERGER, AMY B (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:HEIMBERGER
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 1:675 N SAINT CLAIR ST STE 20-100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5970
Mailing Address - Country:US
Mailing Address - Phone:312-695-8143
Mailing Address - Fax:312-695-4430
Practice Address - Street 1:675 N SAINT CLAIR ST STE 20-100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5970
Practice Address - Country:US
Practice Address - Phone:312-695-8143
Practice Address - Fax:312-695-4430
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL64222086X0206X
IL036155266207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152169201Medicaid
H65715Medicare UPIN
TX152169201Medicaid