Healthcare Provider Details

I. General information

NPI: 1376591511
Provider Name (Legal Business Name): SORREL E. FAGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD SUITE 4001 BROCK
ELK GROVE VILLAGE IL
60007-3311
US

IV. Provider business mailing address

800 BIESTERFIELD RD SUITE 4001 BROCK
ELK GROVE VILLAGE IL
60007-3311
US

V. Phone/Fax

Practice location:
  • Phone: 847-981-3670
  • Fax: 847-956-5421
Mailing address:
  • Phone: 847-981-3670
  • Fax: 847-956-5421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036044477
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: