Basic Information
| Provider Information | |||||||||
| NPI: | 1164491817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYLSMA | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | WILBURN | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 N MICHIGAN AVE | ||||||||
| Address2: | STE 2210 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606017455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477384528 | ||||||||
| FaxNumber: | 8473944176 | ||||||||
| Practice Location | |||||||||
| Address1: | 3375 N ARLINGTON HEIGHTS RD | ||||||||
| Address2: | SUITE K | ||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600047701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477384528 | ||||||||
| FaxNumber: | 8473944176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103G00000X | 071-005398 | IL | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.