Basic Information
| Provider Information | |||||||||
| NPI: | 1366693418 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JAMES C. FERLMANN, M.D., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 SPALDING DR | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605406508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309228825 | ||||||||
| FaxNumber: | 6303698838 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 SPALDING DR | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605406508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309228825 | ||||||||
| FaxNumber: | 6303698838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2008 | ||||||||
| LastUpdateDate: | 12/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | FERLMANN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6309228825 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 036079730 | IL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1366693418 | 01 | IL | BLUECROSSBLUESHIELD BILLING PROVIDER NPI | OTHER | 036079730 | 05 | IL | MEDICAID | 4505664 | 01 | IL | BCBS ID | OTHER |