Provider Demographics
NPI:1871715227
Name:HEARTLAND PRIMARY CARE SC
Entity type:Organization
Organization Name:HEARTLAND PRIMARY CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SRILAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-854-3235
Mailing Address - Street 1:215 REMINGTON BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3656
Mailing Address - Country:US
Mailing Address - Phone:630-378-4880
Mailing Address - Fax:630-378-4481
Practice Address - Street 1:215 REMINGTON BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3662
Practice Address - Country:US
Practice Address - Phone:630-378-4880
Practice Address - Fax:630-378-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336-071828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109580OtherLICENSE