Healthcare Provider Details

I. General information

NPI: 1568434942
Provider Name (Legal Business Name): FRED J HALLORAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11904 OAK CREEK PKWY
HUNTLEY IL
60142-6728
US

IV. Provider business mailing address

11904 OAK CREEK PKWY
HUNTLEY IL
60142-6728
US

V. Phone/Fax

Practice location:
  • Phone: 847-506-1478
  • Fax: 224-858-4001
Mailing address:
  • Phone: 847-506-1478
  • Fax: 224-858-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036081972
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: