Provider Demographics
NPI:1144290560
Name:FREY, KERE (DO)
Entity type:Individual
Prefix:
First Name:KERE
Middle Name:
Last Name:FREY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 W TAYLOR ST STE 3200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7232
Mailing Address - Country:US
Mailing Address - Phone:312-996-4037
Mailing Address - Fax:708-216-1249
Practice Address - Street 1:1740 W TAYLOR ST STE 3200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-996-4037
Practice Address - Fax:708-216-1249
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084504207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36084504Medicaid
G63046Medicare UPIN
ILK12333Medicare ID - Type Unspecified
ILK12332Medicare ID - Type Unspecified