Provider Demographics
NPI:1295822450
Name:CHRISTOPHER HEFFNER,M.D. OF ILLINOIS, P.C.
Entity Type:Organization
Organization Name:CHRISTOPHER HEFFNER,M.D. OF ILLINOIS, P.C.
Other - Org Name:CHRISTOPHER HEFFNER, M.D. OF ILLINOIS, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-222-9192
Mailing Address - Street 1:4600 MEMORIAL DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5366
Mailing Address - Country:US
Mailing Address - Phone:618-222-9192
Mailing Address - Fax:618-222-9234
Practice Address - Street 1:4600 MEMORIAL DR
Practice Address - Street 2:SUITE 330
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5366
Practice Address - Country:US
Practice Address - Phone:618-222-9192
Practice Address - Fax:618-222-9234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214233Medicare PIN