1669419305 NPI number — AL J FRAISER CST CFA

Table of content: AL J FRAISER CST CFA (NPI 1669419305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669419305 NPI number — AL J FRAISER CST CFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRAISER
Provider First Name:
AL
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CST CFA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1669419305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 N WINCHESTER AVE
Provider Second Line Business Mailing Address:
3RD FL
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-250-0500
Provider Business Mailing Address Fax Number:
773-250-0497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 W 156TH ST
Provider Second Line Business Practice Location Address:
STE 208
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-331-6669
Provider Business Practice Location Address Fax Number:
708-333-9902
Provider Enumeration Date:
06/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZS0410X , 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)