Healthcare Provider Details

I. General information

NPI: 1992573117
Provider Name (Legal Business Name): MICHAEL FRUEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 CENTRAL AVE
NORTHFIELD IL
60093-3006
US

IV. Provider business mailing address

405 CENTRAL AVE
NORTHFIELD IL
60093-3006
US

V. Phone/Fax

Practice location:
  • Phone: 630-453-7595
  • Fax:
Mailing address:
  • Phone: 630-453-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: