Basic Information
| Provider Information | |||||||||
| NPI: | 1750548384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEIDEN | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | BERNADETTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CARPIZO | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
| OtherMiddleName: | HEIDEN | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 161 W KINZIE ST | ||||||||
| Address2: | UNIT 812 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606544514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9177502645 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1725 W. HARRISON STREET, SUITE 818 | ||||||||
| Address2: | RUSH UNIVERSITY MEDICAL CENTER | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129426511 | ||||||||
| FaxNumber: | 3129426520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 07/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35-094793 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036-126341 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.