Healthcare Provider Details

I. General information

NPI: 1932159100
Provider Name (Legal Business Name): FREDERICK J DRESSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E SHAWNEE DR
MURPHYSBORO IL
62966-7048
US

IV. Provider business mailing address

PO BOX 1105
INDIANAPOLIS IN
46206-1105
US

V. Phone/Fax

Practice location:
  • Phone: 618-684-1035
  • Fax: 618-687-1155
Mailing address:
  • Phone: 618-549-5361
  • Fax: 618-457-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036075922
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: