Provider Demographics
NPI:1932130366
Name:MCCOMBS, HEATHER (DPM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MCCOMBS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004952213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004952Medicaid
K05479Medicare ID - Type Unspecified
IL5637610001Medicare NSC
K05480Medicare ID - Type Unspecified
U82537Medicare UPIN