Tiesenga, Frederick M

Tiesenga, Frederick M is an individual health care provider with primary practice located at 1950 N Harlem Ave , Elmwood Park IL 60707-3717. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Tiesenga, Frederick M can be contacted via phone (708) 453-6800.

Contact Information

Primary practice address
1950 N Harlem Ave Elmwood Park IL 60707-3717
Phone: (708) 453-6800
Fax: (708) 453-3235
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 36086475 Illinois

Profile Details

NPI number 1801875679
LBN Legal business name Tiesenga, Frederick M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2006
Last updated Apr 26th, 2022 - about 2 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801875679 NPPES
Illinois Other 390720 MEDICARE
Illinois MEDICAID 36086475 MEDICARE

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