Provider Demographics
NPI:1013913573
Name:HEJNA, MICHAEL J (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:HEJNA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 E BURLINGTON ST
Mailing Address - Street 2:STE 100
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2082
Mailing Address - Country:US
Mailing Address - Phone:708-442-0221
Mailing Address - Fax:708-442-5670
Practice Address - Street 1:353 E BURLINGTON ST
Practice Address - Street 2:STE 100
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2082
Practice Address - Country:US
Practice Address - Phone:708-442-0221
Practice Address - Fax:708-442-5670
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091139207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00075953OtherRAILROAD MEDICARE
IL123175300OtherUS DEPARTMENT OF LABOR
IL01633451OtherBLUE CROSS BLUE SHIELD
IL036091139Medicaid
IL036091139Medicaid
ILK00597Medicare ID - Type Unspecified