Provider Demographics
NPI:1689605024
Name:HEATHER N. MCCOMBS, DPM, LLC
Entity Type:Organization
Organization Name:HEATHER N. MCCOMBS, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-944-0000
Mailing Address - Street 1:980 N MICHIGAN AVE
Mailing Address - Street 2:STE 1100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4501
Mailing Address - Country:US
Mailing Address - Phone:312-944-0000
Mailing Address - Fax:312-944-0007
Practice Address - Street 1:980 N MICHIGAN AVE
Practice Address - Street 2:STE 1100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4501
Practice Address - Country:US
Practice Address - Phone:312-944-0000
Practice Address - Fax:312-944-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
208748Medicare ID - Type Unspecified
208747Medicare ID - Type Unspecified
IL5637610001Medicare NSC