Provider Demographics
NPI:1134118987
Name:FRETZIN, MICHAEL H (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:FRETZIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W LAKE COOK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2089
Mailing Address - Country:US
Mailing Address - Phone:847-459-6611
Mailing Address - Fax:847-459-7929
Practice Address - Street 1:600 W LAKE COOK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2089
Practice Address - Country:US
Practice Address - Phone:847-459-6611
Practice Address - Fax:847-459-7929
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-102194207NS0135X
IL036102194207N00000X, 207NI0002X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212426OtherMEDICARE GROUP PRAC ID
IL7482152OtherAETNA
IL31601993OtherBCBS OF ILLINOIS PIN
IL1989945OtherUNITED HEALTHCARE PIN
ILK21892Medicare PIN
ILH16889Medicare UPIN