Organization
HEARTLAND INTERNATIONAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HUELL LYLE COLLIER (CREDENTIALING MANAGER)
(773) 296-7544
Entity
Organization
Contact information
Practice address
3048 N WILTON AVE FL 2, CHICAGO, IL 60657-6710
(773) 296-7544
(773) 296-7637
Mailing address
3048 N WILTON AVE FL 2, CHICAGO, IL 60657-6710
(773) 296-7544
(773) 296-7637
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
63843377001
—
IL
Enumeration date
09/28/2018
Last updated
09/28/2018
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