Individual
DEAN FONDAHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 E MILLER RD, STERLING, IL 61081-1252
(815) 625-4790
Mailing address
PO BOX 5009, BRENTWOOD, TN 37024-5009
(615) 221-3642
(615) 371-4600
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036066790
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012794
HEALTH ALLIANCE MEDICAL
IL
05
—
036066790
—
IL
01
—
340007312
RAILROAD
—
01
—
9815737
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/10/2006
Last updated
12/03/2018
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