Provider Demographics
NPI:1457354656
Name:BEHM, FREDERICK G (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:G
Last Name:BEHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY, MC847
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-3150
Mailing Address - Fax:312-413-0156
Practice Address - Street 1:840 S WOOD ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY, MC847
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-3150
Practice Address - Fax:312-413-0156
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN16605207ZP0101X
IL036-116729207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3808979Medicaid
TN3808979Medicaid
TNG51413Medicare UPIN