Fernald, Jorge E
Fernald, Jorge E is an sole proprietor health care provider with primary practice located at 7300 W College Dr Suite #101, Palos Heights IL 60463. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry. Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry is his primary health care specialty. Fernald, Jorge E can be contacted via phone (708) 448-8470.Contact Information
Primary practice address
7300 W College Dr Suite #101
Palos Heights IL 60463
Phone: (708) 448-8470
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 036-085526 | Illinois |
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry | 2084P0804X | 036-095526 | Illinois |
Profile Details
NPI number | 1912056326 |
---|---|
LBN Legal business name | Fernald, Jorge E |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Jan 9th, 2007 |
Last updated | Aug 23rd, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1912056326 | NPPES |
Illinois | MEDICAID | 036095526 | |
Illinois | Other | F400488988 |
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