Healthcare Provider Details

I. General information

NPI: 1063870525
Provider Name (Legal Business Name): WHITNEY FRITZIE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST SUITE 320
CHICAGO IL
60657-5188
US

IV. Provider business mailing address

900 N WESTMORELAND RD SUITE 222
LAKE FOREST IL
60045-1674
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-3636
  • Fax: 773-296-3639
Mailing address:
  • Phone: 847-234-6121
  • Fax: 847-735-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.005717
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55181
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number085.005717
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: