Provider Demographics
NPI:1255395737
Name:HEILMAN, JUDITH (NP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:HEILMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-575-5000
Mailing Address - Fax:
Practice Address - Street 1:1705 W 25TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3544
Practice Address - Country:US
Practice Address - Phone:219-884-2011
Practice Address - Fax:219-844-0211
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000992A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200451860Medicaid
IN703060PMedicare PIN
IN164210MMedicare PIN
IN164220MMedicare PIN