Provider Demographics
NPI:1962457341
Name:FOURNIER, JOHN HARRY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HARRY
Last Name:FOURNIER
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 1:5201 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656
Mailing Address - Country:US
Mailing Address - Phone:773-774-2102
Mailing Address - Fax:773-774-3581
Practice Address - Street 1:5201 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656
Practice Address - Country:US
Practice Address - Phone:773-774-2102
Practice Address - Fax:773-774-3581
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036041702207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC41861Medicare UPIN