Individual
FREDERICK M TIESENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1950 N HARLEM AVE, ELMWOOD PARK, IL 60707-3717
(708) 453-6800
(708) 453-3235
Mailing address
1950 N HARLEM AVE, ELMWOOD PARK, IL 60707
(708) 453-6800
(708) 453-3985
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
36086475
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36086475
—
IL
01
—
390720
MEDICARE
IL
Enumeration date
01/11/2006
Last updated
04/26/2022
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