Provider Demographics
NPI:1336206150
Name:HELLER-BAIR, ILAH MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ILAH
Middle Name:MARIE
Last Name:HELLER-BAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15505 127TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-4433
Mailing Address - Country:US
Mailing Address - Phone:630-257-5400
Mailing Address - Fax:630-257-1954
Practice Address - Street 1:15505 127TH ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4433
Practice Address - Country:US
Practice Address - Phone:630-257-5400
Practice Address - Fax:630-257-1954
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110756207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL276OtherSILVER CROSS MANAGED CARE
IL036110756Medicaid
IL5936374OtherAETNA
6599328OtherCIGNA HEALTH CARE
IL01634883OtherBLUE CROSS, BLUE SHIELD O
IL5936374OtherAETNA
IL036110756Medicaid