Provider Demographics
NPI:1578777074
Name:FRIBERG MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:FRIBERG MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:FRIBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-835-3388
Mailing Address - Street 1:385 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1551
Mailing Address - Country:US
Mailing Address - Phone:847-835-3388
Mailing Address - Fax:847-835-3637
Practice Address - Street 1:385 PARK AVE
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1551
Practice Address - Country:US
Practice Address - Phone:847-835-3388
Practice Address - Fax:847-835-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-06360207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15590Medicare UPIN
IL745600Medicare ID - Type Unspecified