Individual
ANTHONY FIEDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1414 MAIN ST, MELROSE PARK, IL 60160-3902
(708) 786-8522
(708) 681-3958
Mailing address
1414 MAIN ST, MELROSE PARK, IL 60160-3902
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
36-2709982
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36-2709982
TAX ID
—
Enumeration date
12/10/2012
Last updated
12/10/2012
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