Individual
DR. EDWARD KENT FRYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
455 W COURT ST, STE 403, KANKAKEE, IL 60901-3679
(815) 939-3190
(815) 935-5101
Mailing address
455 W COURT ST, STE 403, KANKAKEE, IL 60901-3679
(815) 939-3190
(815) 935-5101
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036081908
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03081908
—
IL
01
—
4600208
BLUE CROSS BLUE SHIELD
IL
01
—
IL1789
MEDICARE GROUP PTAN
IL
01
—
IL1789002
MEDICARE PTAN
IL
Enumeration date
11/02/2005
Last updated
08/30/2011
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