Fries, David

Fries, David is an sole proprietor health care provider with primary practice located at 671 S Lewis Ave , Waukegan IL 60085-6101. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Fries, David can be contacted via phone (847) 782-4130.

Contact Information

Primary practice address
671 S Lewis Ave Waukegan IL 60085-6101
Phone: (847) 782-4130
Fax: (847) 782-1030
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 149.006690 Illinois

Profile Details

NPI number 1386091965
LBN Legal business name Fries, David
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 24th, 2016
Last updated May 24th, 2016 - about 10 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 1386091965 NPPES
Illinois MEDICAID 1669583001

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