Provider Demographics
NPI:1538272190
Name:FROEHLING, ALAN L (MD)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:L
Last Name:FROEHLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-5116
Mailing Address - Country:US
Mailing Address - Phone:618-242-4750
Mailing Address - Fax:618-242-7674
Practice Address - Street 1:302 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-5116
Practice Address - Country:US
Practice Address - Phone:618-242-4750
Practice Address - Fax:618-242-7674
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059050207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL042064OtherTRICARE
IL200002086OtherRAILROAD MEDICARE
IL080959OtherHEALTH ALLIANCE
IL4100074OtherBLUE CROSS BLUE SHIELD
IL036059050Medicaid
IL113361OtherHEALTHLINK
IL46734OtherGHP
IL200002086OtherRAILROAD MEDICARE
IL080959OtherHEALTH ALLIANCE
ILL66466Medicare ID - Type Unspecified