Provider Demographics
NPI:1851623342
Name:FRADEN INC
Entity Type:Organization
Organization Name:FRADEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-433-8065
Mailing Address - Street 1:1770 1ST ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3200
Mailing Address - Country:US
Mailing Address - Phone:847-433-8065
Mailing Address - Fax:847-433-8447
Practice Address - Street 1:1770 FIRST STREET
Practice Address - Street 2:SUITE 330
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2538
Practice Address - Country:US
Practice Address - Phone:847-433-8065
Practice Address - Fax:847-433-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360841122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty