MEDICARE: CHARLES FREY JR. DO

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
1	207K00000X	Allergy & Immunology Physician	036063367	IL
2	2080P0201X	Pediatric Allergy/Immunology Physician	036063367	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356321244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES FREY JR. DO

Provider Business Mailing Address
First Line	:	698 FEATHERSTONE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-6303
Country	:	US
Telephone Number	:	815-398-3277
Fax Number	:	815-484-7001

Provider Business Practice Location Address
First Line	:	698 FEATHERSTONE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-6303
Country	:	US
Telephone Number	:	815-398-3277
Fax Number	:	815-484-7001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	09/21/2011

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Directions to “ CHARLES FREY JR. DO” Practice Location

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