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NPI Code Detail

MEDICARE: DR. GARY RICHARD FAHRENBACH M.D.

MEDICARE: DR. GARY RICHARD FAHRENBACH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RR0500XRheumatology Physician03657385IL

General Provider Information

NPI Number : 1043303803
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY RICHARD FAHRENBACH M.D.
Provider Business Mailing Address
First Line : 7411 N MILWAUKEE AVE
Second Line :
City : NILES
State : IL
Zip : 60714-3707
Country : US
Telephone Number : 773-763-1818
Fax Number : 773-763-9381
Provider Business Practice Location Address
First Line : 7411 N MILWAUKEE AVE
Second Line :
City : NILES
State : IL
Zip : 60714-3707
Country : US
Telephone Number : 773-763-1818
Fax Number : 773-763-9381
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 08/26/2024

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