Healthcare Provider Details

I. General information

NPI: 1700859089
Provider Name (Legal Business Name): FREYA G PAJE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 E NATIONAL AVE
BRAZIL IN
47834-2713
US

IV. Provider business mailing address

1011 E NATIONAL AVE
BRAZIL IN
47834-2713
US

V. Phone/Fax

Practice location:
  • Phone: 812-446-3278
  • Fax: 812-446-3508
Mailing address:
  • Phone: 812-446-3278
  • Fax: 812-446-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number01049698A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: