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General NPI Number Information
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NPI Number | 1578777074
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Entity Type | Organization
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Legal Business Name | FRIBERG MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 385 PARK AVE
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City | GLENCOE
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State | IL
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Zip | 60022-1551
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Country | US
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Telephone | 847-835-3388
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Fax | 847-835-3637
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Provider Business Mailing Address
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Address Line | 385 PARK AVE
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City | GLENCOE
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State | IL
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Zip | 60022-1551
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Country | US
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Telephone | 847-835-3388
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Fax | 847-835-3637
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JAN CARL FRIBERG
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Credential |
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Telephone | 847-835-3388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 36-06360
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License Number State | IL
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