Provider Demographics
NPI:1376591511
Name:FAGEL, SORREL E (MD)
Entity type:Individual
Prefix:DR
First Name:SORREL
Middle Name:E
Last Name:FAGEL
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 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 4001 BROCK
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3311
Mailing Address - Country:US
Mailing Address - Phone:847-981-3670
Mailing Address - Fax:847-956-5421
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 4001 BROCK
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-981-3670
Practice Address - Fax:847-956-5421
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044477207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42458Medicare UPIN
IL495542Medicare ID - Type Unspecified