MEDICARE: MICHAEL H FRETZIN MD

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
1	207NS0135X	Procedural Dermatology Physician	036-102194	IL
2	207N00000X	Dermatology Physician	036102194	IL
3	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	036102194	IL
4	207ND0900X	Dermatopathology Physician	036102194	IL

General Provider Information

NPI Number	:	1134118987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL H FRETZIN MD

Provider Business Mailing Address
First Line	:	600 W LAKE COOK RD
Second Line	:	SUITE 110
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-2089
Country	:	US
Telephone Number	:	847-459-6611
Fax Number	:	847-459-7929

Provider Business Practice Location Address
First Line	:	600 W LAKE COOK RD
Second Line	:	SUITE 110
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-2089
Country	:	US
Telephone Number	:	847-459-6611
Fax Number	:	847-459-7929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	12/23/2015

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Directions to “ MICHAEL H FRETZIN MD” Practice Location

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