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General NPI Number Information
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NPI Number | 1902842628
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Entity Type | Individual
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Provider Name | NANCY ELAINE FRITZ MD
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Gender | Female
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1900 W POLK ST ADOLESCENT DIVISION, #1104
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City | CHICAGO
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State | IL
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Zip | 60612-3723
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Country | US
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Telephone | 312-689-7466
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Fax | 312-864-9721
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Provider Business Mailing Address
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Address Line | 6940 S CONSTANCE AVE
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City | CHICAGO
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State | IL
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Zip | 60649-1508
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Country | US
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Telephone | 773-667-2002
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 036072927
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License Number State | IL
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