Healthcare Provider Details

I. General information

NPI: 1770756215
Provider Name (Legal Business Name): NICHOLAS C. FRISCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21481 N. RAND RD., 2ND FL NCH COMMUNITY HEALTHCARE
KILDEER IL
60047-3061
US

IV. Provider business mailing address

1431 N WESTERN AVE
CHICAGO IL
60622-1797
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9544
  • Fax:
Mailing address:
  • Phone: 773-235-1915
  • Fax: 773-235-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number036.135181
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036135181
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: