Provider Demographics
NPI:1659475242
Name:BARBER, FREDERICK ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:ALLAN
Last Name:BARBER
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 1:1219 N KENICWORTH
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302
Mailing Address - Country:US
Mailing Address - Phone:708-386-1055
Mailing Address - Fax:
Practice Address - Street 1:7632 W NORTH AVE
Practice Address - Street 2:WEST SUBURBAN FAMILY PRACTICE ASSOC LTD
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707
Practice Address - Country:US
Practice Address - Phone:708-451-4420
Practice Address - Fax:708-456-9817
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12741Medicare UPIN
477330Medicare ID - Type Unspecified