Heredia, Elizabeth W

Heredia, Elizabeth W is an individual health care provider with primary practice located at 2900 Foxfield Rd , St Charles IL 60174-5799. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Heredia, Elizabeth W can be contacted via phone (630) 377-7900.

Contact Information

Primary practice address
2900 Foxfield Rd St Charles IL 60174-5799
Phone: (630) 377-7900
Fax: (630) 377-8007
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036092002 Illinois

Profile Details

NPI number 1194755843
LBN Legal business name Heredia, Elizabeth W
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 4th, 2006
Last updated Apr 4th, 2013 - about 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194755843 NPPES
Illinois MEDICAID 036100523
Illinois Other 0222075
Illinois Other 3631498336019001

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