Individual
SARA JANE FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 307-7799
(630) 307-2277
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 307-7799
(630) 307-2277
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036076758
IL
2086X0206X
Surgical Oncology Physician
036076758
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036076758
—
IL
01
—
206147220
MEDICARE (INDIVIDUAL PTAN)
IL
01
—
2215516
BLUE CROSS BLUE SHIELD
IL
01
—
4062703
AETNA
IL
Enumeration date
05/03/2006
Last updated
01/03/2018
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