Individual
MR. FREDERICK OTTO KIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1615 PHEASANT TRL, INVERNESS, IL 60067-4619
(847) 358-6526
(847) 358-6536
Mailing address
1615 PHEASANT TRL, INVERNESS, IL 60067-4619
(847) 358-6526
(847) 358-6536
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
08/03/2006
Last updated
07/08/2007
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