Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | IL | |
Y | 213EG0000X | General Practice | IL |
NPI | 1003813684 |
---|---|
Provider Name | Dr. Thomas J Frymark |
First Address | Johnsburg, IL 60050-1003 |
Second Address | Johnsburg, IL 60050-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 08/07/2007 |