Provider Demographics
NPI:1386634145
Name:FABI & ASSOCIATES SC
Entity Type:Organization
Organization Name:FABI & ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:FABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-474-8844
Mailing Address - Street 1:PO BOX 1419
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-4419
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:18127 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3921
Practice Address - Country:US
Practice Address - Phone:708-474-8844
Practice Address - Fax:708-474-6135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635587OtherBCBSIL GROUP #
IL211824Medicare PIN
IL1635587OtherBCBSIL GROUP #
ILK18260Medicare PIN
ILDE0914Medicare PIN