Individual
DR. JAMES FREDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
675 N SAINT CLAIR ST, GALTER, SUITE 19-012, CHICAGO, IL 60611-5975
(312) 695-2885
(312) 695-2461
Mailing address
676 N SAINT CLAIR ST, SUITE 1700, CHICAGO, IL 60611-2927
(312) 695-4868
(312) 695-6854
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
36057651
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L035691-EA08
CHAMPUSTRICARE
IL
Enumeration date
01/18/2007
Last updated
07/08/2007
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