Individual
DR. MATTHEW TAYLOR HEFTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
215 E 1ST ST STE 316, DIXON, IL 61021-3190
(815) 285-5842
(815) 285-5845
Mailing address
215 E 1ST ST STE 316, DIXON, IL 61021-3190
(815) 285-5842
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036147642
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
376897
HEALTH ALLIANCE PROVIDER NUMBER
IL
01
—
4301096886
EDUCATIONAL LIMITED LICENSE
MI
01
—
F400525521
MEDICARE PTAN
IL
Enumeration date
07/12/2010
Last updated
10/08/2019
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