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NPI Code Detail

MEDICARE: MOLLY FREY

MEDICARE: MOLLY FREY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1093108664
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY FREY
Provider Business Mailing Address
First Line : 1117 N DEARBORN ST
Second Line : APT 411
City : CHICAGO
State : IL
Zip : 60610-2701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1117 N DEARBORN ST
Second Line : APT 411
City : CHICAGO
State : IL
Zip : 60610-2701
Country : US
Telephone Number : 815-245-9801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2015
Last Update Date : 03/06/2015

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Directions to “ MOLLY FREY ” Practice Location

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