Provider Demographics
NPI: | 1306854021 |
---|---|
Name: | FRIEDELL CLINIC, S. C. |
Entity Type: | Organization |
Organization Name: | FRIEDELL CLINIC, S. C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | NELSON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | VASQUEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 773-947-7989 |
Mailing Address - Street 1: | 7531 S STONY ISLAND AVE STE 251 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60649-3993 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 773-947-7785 |
Mailing Address - Fax: | 773-947-7792 |
Practice Address - Street 1: | 1625 E 75TH ST |
Practice Address - Street 2: | |
Practice Address - City: | CHICAGO |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60649-3603 |
Practice Address - Country: | US |
Practice Address - Phone: | 773-947-2828 |
Practice Address - Fax: | 773-947-7792 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-05 |
Last Update Date: | 2020-01-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
042-005610 | 207L00000X | |
IL | 042-005610 | 207Q00000X, 207V00000X, 207X00000X, 207XS0106X, 207ZF0201X, 207ZP0105X, 207ZP0213X, 208000000X, 2084A0401X, 2084P0800X, 208600000X, 208D00000X, 208M00000X |
IL | 042005610 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207ZF0201X | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology | Group - Multi-Specialty |
No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Multi-Specialty |
No | 207ZP0213X | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty |