Healthcare Provider Details

I. General information

NPI: 1750841219
Provider Name (Legal Business Name): ANITA FRIES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL LN STE 200
DANVILLE IN
46122-1993
US

IV. Provider business mailing address

100 HOSPITAL LN STE 200
DANVILLE IN
46122-1993
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-7337
  • Fax: 317-745-3093
Mailing address:
  • Phone: 317-745-7337
  • Fax: 317-745-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02006767A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: