Basic Information
| Provider Information | |||||||||
| NPI: | 1568417780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIMMEL | ||||||||
| FirstName: | CLAUS | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 RIDGE AVE | ||||||||
| Address2: | BURCH BUILDLING, ROOM 103 A | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602011718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701762 | ||||||||
| FaxNumber: | 8477335310 | ||||||||
| Practice Location | |||||||||
| Address1: | 2160 S FIRST AVE | ||||||||
| Address2: | (15750 MARION DRIVE, HOMER GLEN, IL. 60491) | ||||||||
| City: | MAYWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086453400 | ||||||||
| FaxNumber: | 7086453411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 08/30/2013 | ||||||||
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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 | 207R00000X | 036115700 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 036115700 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.