| Fred J. Halloran, Md, Sc | |
|
11904 Oak Creek Pkwy Huntley IL 60142-6728 | |
| (847) 506-1478 | |
| (224) 858-4001 |
| Full Name | Fred J. Halloran, Md, Sc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11904 Oak Creek Pkwy, Huntley, Illinois |
| Authorized Official Name and Position | Fred J. Halloran (OWNER) |
| Authorized Official Contact | 8475061478 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fred J. Halloran, Md, Sc 11904 Oak Creek Pkwy Huntley IL 60142-6728 Ph: (847) 506-1478 | Fred J. Halloran, Md, Sc 11904 Oak Creek Pkwy Huntley IL 60142-6728 Ph: (847) 506-1478 |
| NPI Number | 1295906774 |
|---|---|
| Provider Enumeration Date | 03/12/2008 |
| Last Update Date | 01/17/2024 |
| Medicare PECOS PAC ID | 5799699831 |
|---|---|
| Medicare Enrollment ID | O20031113000658 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295906774 | NPI | - | NPPES |
| 036081972 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036081972 (Illinois) | Primary |
| Provider Name | Fred J Halloran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568434942 PECOS PAC ID: 6406760552 Enrollment ID: I20031113000704 |
| Provider Name | Lisa M Petrongelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306281332 PECOS PAC ID: 1153229885 Enrollment ID: I20031219000456 |
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