Provider Demographics
NPI:1871578310
Name:SCELZO, FREDERICK A (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:A
Last Name:SCELZO
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 1:2150 PFINGSTEN RD
Mailing Address - Street 2:SUITE 2240
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1361
Mailing Address - Country:US
Mailing Address - Phone:847-724-5608
Mailing Address - Fax:
Practice Address - Street 1:2150 PFINGSTEN RD
Practice Address - Street 2:SUITE 2240
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1361
Practice Address - Country:US
Practice Address - Phone:847-724-5608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043476207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC41820Medicare UPIN
471130Medicare ID - Type Unspecified