Basic Information
| Provider Information | |||||||||
| NPI: | 1538541982 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRASER | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | WOLD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WOLD | ||||||||
| OtherFirstName: | LINDSEY | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 71 WAUKEGAN RD STE 700 | ||||||||
| Address2: | |||||||||
| City: | LAKE BLUFF | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600441614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476638060 | ||||||||
| FaxNumber: | 8476631027 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 WAUKEGAN RD STE 700 | ||||||||
| Address2: | |||||||||
| City: | LAKE BLUFF | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600441614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474332620 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2015 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 19517 | NH | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 036153383 | IL | N | Allopathic & Osteopathic Physicians | Dermatology | 207NP0225X | 19517 | NH | N | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology | 207R00000X | 125-066870 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207N00000X | 036.153383 | IL | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.