Healthcare Provider Details

I. General information

NPI: 1538541982
Provider Name (Legal Business Name): LINDSEY WOLD FRASER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY ANN WOLD M.D.

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 WAUKEGAN RD STE 700
LAKE BLUFF IL
60044-1614
US

IV. Provider business mailing address

71 WAUKEGAN RD STE 700
LAKE BLUFF IL
60044-1614
US

V. Phone/Fax

Practice location:
  • Phone: 847-433-2620
  • Fax:
Mailing address:
  • Phone: 847-663-8060
  • Fax: 847-663-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number19517
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036153383
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number19517
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125-066870
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036.153383
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: