1386729424 NPI number — FREDERIC K RENOLD MD SC

Table of content: (NPI 1386729424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386729424 NPI number — FREDERIC K RENOLD MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDERIC K RENOLD MD SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AARONSON ASTHMA & ALLERGY ASSOC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386729424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9301 GOLF RD
Provider Second Line Business Mailing Address:
STE 301
Provider Business Mailing Address City Name:
DES PLAINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60016-1667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-635-7300
Provider Business Mailing Address Fax Number:
847-635-7556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9301 GOLF RD
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
DES PLAINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60016-1667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-635-7300
Provider Business Practice Location Address Fax Number:
847-635-7556
Provider Enumeration Date:
10/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RENOLD
Authorized Official First Name:
FREDERIC
Authorized Official Middle Name:
K
Authorized Official Title or Position:
ALLERGIST
Authorized Official Telephone Number:
847-695-7300

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)