Healthcare Provider Details

I. General information

NPI: 1225398621
Provider Name (Legal Business Name): DAWES FRETZIN CLINICAL RESEARCH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8103 CLEARVISTA PKWY SUITE 260
INDIANAPOLIS IN
46256-5628
US

IV. Provider business mailing address

8103 CLEARVISTA PKWY SUITE 260
INDIANAPOLIS IN
46256-5628
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-7790
  • Fax: 317-621-7791
Mailing address:
  • Phone: 317-621-7790
  • Fax: 317-621-7791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT A FRETZIN
Title or Position: MEMBER/OWNER
Credential: M.D.
Phone: 317-621-7790