Provider Demographics
NPI:1356827877
Name:FADZL, DANETTE (MEDICAL BILLING)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:FADZL
Suffix:
Gender:F
Credentials:MEDICAL BILLING
Other - Prefix:
Other - First Name:DANETTE
Other - Middle Name:
Other - Last Name:FADZL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1406 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-1510
Mailing Address - Country:US
Mailing Address - Phone:312-539-9966
Mailing Address - Fax:
Practice Address - Street 1:1406 E 72ND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-1510
Practice Address - Country:US
Practice Address - Phone:312-539-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400129120602251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health