Individual
MR. PAUL V FAHRENBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7447 W TALCOTT AVE, SUITE 209, CHICAGO, IL 60631-3745
(773) 631-2728
(773) 631-8083
Mailing address
7447 W TALCOTT AVE, SUITE 209, CHICAGO, IL 60631-3745
(773) 631-2728
(773) 631-8083
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036078292
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-078292
—
IL
01
—
110062166
RR MEDICARE
IL
01
—
976660
PTAN
IL
Enumeration date
08/26/2005
Last updated
11/21/2016
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