Organization
HEARTLAND INTERNATIONAL HEALTH CENTER
Active
Other names
Heartland Health Center-Wilson
Organization subpart
No
Provider details
NPI number
Authorized official
GWENN RAUSCH (EXECUTIVE DIRECTOR)
(773) 296-7589
Entity
Organization
Contact information
Practice address
845 W WILSON AVE, CHICAGO, IL 60640-5704
(773) 728-7264
(773) 728-7557
Mailing address
3048 N. WILTON AVE, 2ND FLOOR, CHICAGO, IL 60657-6710
(773) 296-7544
(773) 751-4175
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
003
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103527
DORAL DENTAL
IL
Enumeration date
05/22/2008
Last updated
09/20/2010
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