Hennecke, Ellen M
Hennecke, Ellen M is an individual health care provider with primary practice located at 3927 W 95Th St , Evergreen Park IL 60805-1903. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Hennecke, Ellen M can be contacted via phone (708) 952-4566.Contact Information
Primary practice address
3927 W 95Th St
Evergreen Park IL 60805-1903
Phone: (708) 952-4566
Fax: (708) 952-4568
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | Illinois |
Profile Details
| NPI number | 1699751156 |
|---|---|
| LBN Legal business name | Hennecke, Ellen M |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 16th, 2005 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699751156 | NPPES |
| Illinois | Other | 01628066 | BLUE SHIELD |
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