Provider Demographics
NPI:1679510796
Name:FRAZIER, MARK FREDERICK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:FREDERICK
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 W. RAND RD.
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3985
Mailing Address - Country:US
Mailing Address - Phone:847-259-8583
Mailing Address - Fax:847-259-8935
Practice Address - Street 1:139 WEST RAND RD.
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3982
Practice Address - Country:US
Practice Address - Phone:847-259-8583
Practice Address - Fax:847-259-8935
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003590103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1673206OtherBLUE CROSS BLUE SHIELD
IL680010989OtherRAILROAD MEDICARE
ILL85993Medicare ID - Type UnspecifiedPROVIDER NUMBER