MEDICARE: ANDRE FREDIEU MD

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	2084N0400X	Neurology Physician	P5364	TX
2	2084N0400X	Neurology Physician	31365	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00235877	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	180288	OTHER	VA	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	001746276	OTHER	VA	MOUNTAIN STATE BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578543260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE FREDIEU MD

Provider Business Mailing Address
First Line	:	1245 S UTICA AVE
Second Line	:	3RD FLOOR WEST
City	:	TULSA
State	:	OK
Zip	:	74104-4214
Country	:	US
Telephone Number	:	918-560-3823
Fax Number	:	918-579-2535

Provider Business Practice Location Address
First Line	:	1245 S UTICA AVE
Second Line	:	3RD FLOOR WEST
City	:	TULSA
State	:	OK
Zip	:	74104-4214
Country	:	US
Telephone Number	:	918-560-3823
Fax Number	:	918-579-2535

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	08/11/2015

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Directions to “ ANDRE FREDIEU MD” Practice Location

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