Provider Demographics
NPI:1699985911
Name:OVSIEW, FRED (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:OVSIEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N MCCLURG CT
Mailing Address - Street 2:SUITE 4411
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3044
Mailing Address - Country:US
Mailing Address - Phone:312-643-5522
Mailing Address - Fax:312-643-5523
Practice Address - Street 1:600 N MCCLURG CT
Practice Address - Street 2:SUITE 4411
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3044
Practice Address - Country:US
Practice Address - Phone:312-643-5522
Practice Address - Fax:312-643-5523
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360580902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058090Medicaid
ILC39202Medicare UPIN
IL036058090Medicaid