Provider Demographics
NPI:1699959262
Name:JAMES R. HERRON, MD, LTD
Entity type:Organization
Organization Name:JAMES R. HERRON, MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-291-9083
Mailing Address - Street 1:4008 CHESTER DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1047
Mailing Address - Country:US
Mailing Address - Phone:312-291-9083
Mailing Address - Fax:312-624-9183
Practice Address - Street 1:1030 N CLARK ST
Practice Address - Street 2:STE 647
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5467
Practice Address - Country:US
Practice Address - Phone:312-291-9083
Practice Address - Fax:312-624-9183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042002026261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047483Medicaid