Provider Demographics
NPI:1316151558
Name:FRIBERG MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:FRIBERG MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:FRIBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD, FACO
Authorized Official - Phone:312-642-6777
Mailing Address - Street 1:845 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 935 E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2252
Mailing Address - Country:US
Mailing Address - Phone:312-642-6777
Mailing Address - Fax:312-642-8383
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:SUITE 935 E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-642-6777
Practice Address - Fax:312-642-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36063631207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Multi-Specialty