MEDICARE: DR. DOUGLAS JOHN FROHLICH I D.O.

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	207Q00000X	Family Medicine Physician	036074096	IL
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	036-074096	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036074096	OTHER	IL	IL MEDICAL LICENSE
2	1699960690	OTHER		NPI

General Provider Information

NPI Number	:	1699960690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS JOHN FROHLICH I D.O.

Provider Business Mailing Address
First Line	:	1229 N NORTH BRANCH ST
Second Line	:	SUITE 210
City	:	CHICAGO
State	:	IL
Zip	:	60642-2473
Country	:	US
Telephone Number	:	312-939-5090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 N NORTH BRANCH ST
Second Line	:	SUITE 210
City	:	CHICAGO
State	:	IL
Zip	:	60622-2473
Country	:	US
Telephone Number	:	312-939-5090
Fax Number	:

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

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	11/17/2008

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