Provider Demographics
NPI:1861475964
Name:FAHRENBACH, GREGORY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:FAHRENBACH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 500 NORTHWEST ORTHOPAEDIC ASSOCIATES LTD
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-631-7898
Mailing Address - Fax:773-631-3005
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 500 NORTHWEST ORTHOPAEDIC ASSOCIATES LTD
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-631-7898
Practice Address - Fax:773-631-3005
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-02-04
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Provider Licenses
StateLicense IDTaxonomies
IL036062547207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200026425OtherRAILROAD MEDICARE
131128300OtherUS DEPT OF LABOR
IL1861475964OtherNPI
IL0021604007OtherBSIL
IL036062547Medicaid
IL0242720001OtherDME
IL0021604007OtherBSIL
IL1861475964OtherNPI