Provider Demographics
NPI:1023197332
Name:STRIEDINGER MEDICAL GROUP SC
Entity Type:Organization
Organization Name:STRIEDINGER MEDICAL GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:STRIEDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-878-4700
Mailing Address - Street 1:4733 N DAMEN
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1334
Mailing Address - Country:US
Mailing Address - Phone:773-878-4700
Mailing Address - Fax:
Practice Address - Street 1:4733 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1442
Practice Address - Country:US
Practice Address - Phone:773-878-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090741Medicaid
IL4932289OtherBCBS PROVIDER
IL4932289OtherBCBS PROVIDER
ILG53587Medicare UPIN