Provider Demographics
NPI:1952641649
Name:FRY, WILLARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:A
Last Name:FRY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1500 SHERIDAN RD
Mailing Address - Street 2:#10E
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1873
Mailing Address - Country:US
Mailing Address - Phone:847-256-2532
Mailing Address - Fax:847-256-4903
Practice Address - Street 1:1500 SHERIDAN RD
Practice Address - Street 2:#10E
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1873
Practice Address - Country:US
Practice Address - Phone:847-256-2532
Practice Address - Fax:847-256-4903
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2014-01-30
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Provider Licenses
StateLicense IDTaxonomies
IL036-036903208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)