Frederick Otto Kist
Individual provider Active NPI Contractor · Inverness, IL
NPI 1366450769 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1366450769
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 1615 Pheasant TRL
Inverness, IL 60067-4619 - Phone
- (847) 358-6526
- Fax
- (847) 358-6536
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
1615 Pheasant TRL
Inverness, IL 60067-4619
Mailing address
1615 Pheasant TRL
Inverness, IL 60067-4619
Phone (847) 358-6526
Other providers in Inverness, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.