Provider Demographics
NPI:1386729424
Name:FREDERIC K RENOLD MD SC
Entity type:Organization
Organization Name:FREDERIC K RENOLD MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ALLERGIST
Authorized Official - Prefix:
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:RENOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-695-7300
Mailing Address - Street 1:9301 GOLF RD
Mailing Address - Street 2:STE 301
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1667
Mailing Address - Country:US
Mailing Address - Phone:847-635-7300
Mailing Address - Fax:847-635-7556
Practice Address - Street 1:9301 GOLF RD
Practice Address - Street 2:STE 301
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1667
Practice Address - Country:US
Practice Address - Phone:847-635-7300
Practice Address - Fax:847-635-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA88512Medicare UPIN