1851330112 NPI number — DR. WALTER E FRITZ M.D.

Table of content: DR. WALTER E FRITZ M.D. (NPI 1851330112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851330112 NPI number — DR. WALTER E FRITZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRITZ
Provider First Name:
WALTER
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851330112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1002 S EDGEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOX
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46534-8226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-772-2188
Provider Business Mailing Address Fax Number:
574-772-2190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 S EDGEWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOX
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46534-8226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-772-2188
Provider Business Practice Location Address Fax Number:
574-772-2190
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01024309A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000083056 . This is a "BLUE CROSS PIN NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 87-0778393 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 01024309A . This is a "WALTER FRITZ,M.D. LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200897290 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351301967 . This is a "TAX ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100225090A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200020860A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50000720A . This is a "CORPORATION LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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