Provider Demographics
NPI:1164491817
Name:BYLSMA, FREDERICK WILBURN (PHD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:WILBURN
Last Name:BYLSMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N MICHIGAN AVE
Mailing Address - Street 2:STE 2210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7455
Mailing Address - Country:US
Mailing Address - Phone:847-738-4528
Mailing Address - Fax:847-394-4176
Practice Address - Street 1:3375 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE K
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7701
Practice Address - Country:US
Practice Address - Phone:847-738-4528
Practice Address - Fax:847-394-4176
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
IL071-005398103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILS10183Medicare UPIN
ILK28508Medicare ID - Type UnspecifiedOTHER IL COUNTIES
IL553990Medicare ID - Type Unspecified
ILK28509Medicare ID - Type UnspecifiedCOOK COUNTY
IL553980Medicare ID - Type Unspecified