1609675818 NPI number — HEARTFELT MEDICAL PLLC

Table of content: (NPI 1609675818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609675818 NPI number — HEARTFELT MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTFELT MEDICAL PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609675818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20015 S LAGRANGE RD # 1019
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60423-3104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-821-3923
Provider Business Mailing Address Fax Number:
478-202-9614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20500 N LAGRANGE RD STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60423-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-821-3923
Provider Business Practice Location Address Fax Number:
478-202-9614
Provider Enumeration Date:
03/10/2025

Additional Information

Authorized Official

Authorized Official Last Name:
GROTE
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
708-514-5466

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1588100952 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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