Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 01038758A | IN |
Y | 111NI0900X | Internist | 01038758A | IN |
N | 207RA0401X | Internist - Addiction Medicine | 01038758A | IN |
NPI | 1861468258 |
---|---|
Provider Name | Fred W Frick |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46216-1056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000342145 | ANTHEM (01) | IN |
100334180 | (05) | IN |
C02142 | (02) | IN |
P00971523 | RR MEDICARE (01) | IN |