Provider Demographics
NPI:1609945195
Name:HEROUX, ALAIN L (MD)
Entity Type:Individual
Prefix:
First Name:ALAIN
Middle Name:L
Last Name:HEROUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:EMS BLDG., ROOM 6213
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-9000
Mailing Address - Fax:708-327-2770
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:EMS BLDG., ROOM 6213
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-9000
Practice Address - Fax:708-327-2770
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-079356207R00000X
IL036079356207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12074Medicare ID - Type Unspecified
E30211Medicare UPIN
ILK18812Medicare ID - Type Unspecified
ILK12075Medicare ID - Type Unspecified