Fernald, Jorge E

Fernald, Jorge E is an sole proprietor health care provider with primary practice located at 7300 W College Dr Suite #101, Palos Heights IL 60463. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry. Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry is his primary health care specialty. Fernald, Jorge E can be contacted via phone (708) 448-8470.

Contact Information

Primary practice address
7300 W College Dr Suite #101 Palos Heights IL 60463
Phone: (708) 448-8470
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 036-085526 Illinois
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X 036-095526 Illinois

Profile Details

NPI number 1912056326
LBN Legal business name Fernald, Jorge E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 9th, 2007
Last updated Aug 23rd, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912056326 NPPES
Illinois MEDICAID 036095526
Illinois Other F400488988

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