MEDICARE: DR. ROBERT D. FRITZEN ED.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301001619	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	680B545140	OTHER	MI	BC/BS
2	620B545140	OTHER	MI	HEALTH PLUS OF MI

General Provider Information

NPI Number	:	1396710232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT D. FRITZEN ED.D.

Provider Business Mailing Address
First Line	:	12809 S SAGINAW ST
Second Line	:	SUITE 114
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2416
Country	:	US
Telephone Number	:	810-695-1588
Fax Number	:

Provider Business Practice Location Address
First Line	:	12809 S SAGINAW ST
Second Line	:	SUITE 114
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2416
Country	:	US
Telephone Number	:	810-695-1588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	11/08/2011

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