Provider Demographics
NPI:1568583409
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:312-335-3939
Mailing Address - Street 1:60 E DELAWARE PL
Mailing Address - Street 2:SUITE 1480
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1495
Mailing Address - Country:US
Mailing Address - Phone:312-335-3939
Mailing Address - Fax:312-335-5469
Practice Address - Street 1:60 E DELAWARE PL
Practice Address - Street 2:SUITE 1480
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1495
Practice Address - Country:US
Practice Address - Phone:312-335-3939
Practice Address - Fax:312-335-5469
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 Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID
U82537Medicare UPIN
IL208747Medicare ID - Type Unspecified
IL=========OtherTAX ID