Provider Demographics
NPI:1801895545
Name:VON HEIMBURG, ABBY C (MD)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:C
Last Name:VON HEIMBURG
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 1:3922 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-3179
Mailing Address - Country:US
Mailing Address - Phone:815-578-2020
Mailing Address - Fax:815-344-3241
Practice Address - Street 1:3922 MERCY DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-3179
Practice Address - Country:US
Practice Address - Phone:815-578-2020
Practice Address - Fax:815-344-3241
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085466207P00000X
IL036-085466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085466Medicaid
IL04532206OtherBLUE CROSS BLUE SHIELD
ILP00223549Medicare PIN
IL04532206OtherBLUE CROSS BLUE SHIELD
ILK10477Medicare PIN
IL036085466Medicaid