Provider Demographics
NPI:1972509594
Name:HENIFF, COLLEEN ANN (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANN
Last Name:HENIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2850 W 95TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:708-499-2070
Mailing Address - Fax:708-229-6072
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-499-2070
Practice Address - Fax:708-229-6072
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036091536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG37006Medicare UPIN
IL729903022Medicare PIN