Provider Demographics
NPI:1861584542
Name:FRENKEL, ABRAHAM RAMY (MD)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:RAMY
Last Name:FRENKEL
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 1:7317 N WILLOW LAKE CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-8260
Mailing Address - Country:US
Mailing Address - Phone:309-683-7373
Mailing Address - Fax:309-691-4408
Practice Address - Street 1:7317 N WILLOW LAKE CT
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8260
Practice Address - Country:US
Practice Address - Phone:309-683-7373
Practice Address - Fax:309-691-4408
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361015422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4079OtherRR GROUP #
IL036101542Medicaid
809840OtherMEDICARE GROUP #
P00424276OtherRR INDIVIDUAL #
P00424276OtherRR INDIVIDUAL #
IL036101542Medicaid