Individual
DR. GREGORY J FAHRENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7447 W TALCOTT AVE, SUITE 500 NORTHWEST ORTHOPAEDIC ASSOCIATES LTD, CHICAGO, IL 60631-3745
(773) 631-7898
(773) 631-3005
Mailing address
7447 W TALCOTT AVE, SUITE 500 NORTHWEST ORTHOPAEDIC ASSOCIATES LTD, CHICAGO, IL 60631-3745
(773) 631-7898
(773) 631-3005
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
Primary
036062547
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021604007
BSIL
IL
01
—
0242720001
DME
IL
05
—
036062547
—
IL
01
—
131128300
US DEPT OF LABOR
—
01
—
1861475964
NPI
IL
01
—
200026425
RAILROAD MEDICARE
IL
Enumeration date
11/22/2005
Last updated
02/04/2015
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