Provider Demographics
NPI:1750548384
Name:HEIDEN, KATHERINE BERNADETTE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:BERNADETTE
Last Name:HEIDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:HEIDEN
Other - Last Name:CARPIZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:161 W KINZIE ST
Mailing Address - Street 2:UNIT 812
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4514
Mailing Address - Country:US
Mailing Address - Phone:917-750-2645
Mailing Address - Fax:
Practice Address - Street 1:1725 W. HARRISON STREET, SUITE 818
Practice Address - Street 2:RUSH UNIVERSITY MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-6511
Practice Address - Fax:312-942-6520
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-094793208600000X
IL036-126341208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3020706Medicare PIN