Provider Demographics
NPI:1487827556
Name:HEARTLAND HEALTH INTERNATIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:HEARTLAND HEALTH INTERNATIONAL HEALTH CENTER
Other - Org Name:ROGERS PARK HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BECHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUCAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-751-1704
Mailing Address - Street 1:4750 N SHERIDAN RD
Mailing Address - Street 2:SUITE 434
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7528
Mailing Address - Country:US
Mailing Address - Phone:773-751-1704
Mailing Address - Fax:
Practice Address - Street 1:2200 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-3412
Practice Address - Country:US
Practice Address - Phone:773-751-1704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X, 363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid