Fried, Walter I
Fried, Walter I is an individual health care provider with primary practice located at 3477 Grand Ave , Gurnee IL 60031-3734. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Fried, Walter I can be contacted via phone (847) 249-4660.Contact Information
Primary practice address
3477 Grand Ave
Gurnee IL 60031-3734
Phone: (847) 249-4660
Fax: (847) 249-4950
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 036050042 | Illinois |
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 29201020 | Wisconsin |
Profile Details
| NPI number | 1497741342 |
|---|---|
| LBN Legal business name | Fried, Walter I |
| Credentials | PH.D., M.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 26th, 2005 |
| Last updated | Jan 3rd, 2014 - about 12 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497741342 | NPPES |
| Illinois | MEDICAID | 036050042 |
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