Provider Demographics
NPI:1063870525
Name:FRITZIE, WHITNEY (PA)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:FRITZIE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1674
Mailing Address - Country:US
Mailing Address - Phone:847-234-6121
Mailing Address - Fax:847-735-8734
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE 320
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-296-3636
Practice Address - Fax:773-296-3639
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.005717174400000X, 363A00000X
CA55181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No174400000XOther Service ProvidersSpecialist