Provider Demographics
NPI:1629178363
Name:ADRIENNE L FREGIA MD SC
Entity Type:Organization
Organization Name:ADRIENNE L FREGIA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FREGIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-481-9912
Mailing Address - Street 1:4647 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2319
Mailing Address - Country:US
Mailing Address - Phone:708-481-9912
Mailing Address - Fax:708-481-9914
Practice Address - Street 1:4647 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2319
Practice Address - Country:US
Practice Address - Phone:708-481-9912
Practice Address - Fax:708-481-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF60810Medicare UPIN
IL567130Medicare PIN