Provider Demographics
NPI:1588646756
Name:SWEET, FRED A (MD)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:A
Last Name:SWEET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 MCFARLAND RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6801
Mailing Address - Country:US
Mailing Address - Phone:815-316-2100
Mailing Address - Fax:815-316-2099
Practice Address - Street 1:2902 MCFARLAND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6801
Practice Address - Country:US
Practice Address - Phone:815-316-2100
Practice Address - Fax:815-316-2099
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101976207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101976 2Medicaid
ILH02947Medicare UPIN
ILL97298Medicare ID - Type UnspecifiedILLINOIS