Individual
DR. JACOB RALPH HENINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611
(312) 227-5170
Mailing address
2030W CHURCHILL ST, CHICAGO, IL 60647-5537
(563) 343-3401
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
Primary
036.141802
IL
Other
Enumeration date
03/24/2014
Last updated
04/13/2021
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