Organization
FGM PEDIATRICS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC A FREED DO (CO-OWNER)
(708) 442-7979
Entity
Organization
Contact information
Practice address
8711 W CERMAK RD, NORTH RIVERSIDE, IL 60546-1166
(708) 442-7979
(708) 442-8574
Mailing address
PO BOX 967, TINLEY PARK, IL 60477-0967
(708) 532-6029
(708) 532-6095
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001623614
BC BS OF IL
IL
Enumeration date
05/10/2006
Last updated
05/02/2018
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