Healthcare Provider Details

I. General information

NPI: 1538991989
Provider Name (Legal Business Name): FREMONT FERTILITY PARTNERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W WACKER DR STE 800
CHICAGO IL
60606-1260
US

IV. Provider business mailing address

225 W WACKER DR STE 800
CHICAGO IL
60606-1260
US

V. Phone/Fax

Practice location:
  • Phone: 303-968-1950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANE JEAN RAVECH
Title or Position: CHIEF MANAGED CARE OFFICER
Credential:
Phone: 860-305-6640