Healthcare Provider Details

I. General information

NPI: 1245359041
Provider Name (Legal Business Name): MICHAEL PHILLIP FRAGEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 S NORBURY AVE
LOMBARD IL
60148-6182
US

IV. Provider business mailing address

1615 S NORBURY AVE
LOMBARD IL
60148-6182
US

V. Phone/Fax

Practice location:
  • Phone: 630-627-2511
  • Fax: 847-510-0505
Mailing address:
  • Phone: 630-627-2511
  • Fax: 847-510-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: