Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 125.073652 | IL |
NPI | 1063971059 |
---|---|
Provider Name | Noah Frydenlund |
First Address | Chicago, IL 60611-3055 |
Second Address | Chicago, IL 60611-3055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2019 |
Last Update Date | 07/06/2019 |