Organization
DRS ROBIN & FRETZIN SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JILL SUTHERLAND (SUPERVISOR)
(847) 459-6495
Entity
Organization
Contact information
Practice address
41 S PROSPECT AVE, PARK RIDGE, IL 60068-4138
(847) 823-4113
(847) 823-0059
Mailing address
41 S PROSPECT AVE, PARK RIDGE, IL 60068-4138
(847) 823-4113
(847) 823-0059
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
036022673
IL
207N00000X
Dermatology Physician
036038658
IL
207ND0900X
Dermatopathology Physician
036038658
IL
207NS0135X
Procedural Dermatology Physician
036022673
IL
207NS0135X
Procedural Dermatology Physician
Primary
036038658
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001615219
DF BCBS PROV#
IL
01
—
036038658
DF STATE LIC#
IL
01
—
1891784401
FRETZIN NPI#
—
Enumeration date
05/22/2007
Last updated
06/19/2012
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