MEDICARE: DR. FREDERICK R SPENCER DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	016-003528	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750430104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK R SPENCER DPM

Provider Business Mailing Address
First Line	:	1432 CALCUTTA LN
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-2215
Country	:	US
Telephone Number	:	708-246-4591
Fax Number	:	708-246-2086

Provider Business Practice Location Address
First Line	:	608 HILLGROVE AVE
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1476
Country	:	US
Telephone Number	:	708-246-4591
Fax Number	:	708-246-2086

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	10/13/2008

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