Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 36-063631 | IL |
NPI | 1073666251 |
---|---|
Provider Name | Jan Carl Friberg |
First Address | Glencoe, IL 60022-1551 |
Second Address | Glencoe, IL 60022-1551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |