Healthcare Provider Details

I. General information

NPI: 1346271574
Provider Name (Legal Business Name): FREIDA R THOMPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 CENTURY PLAZA RD STE 265
INDIANAPOLIS IN
46254-5471
US

IV. Provider business mailing address

950 N MERIDIAN ST STE 500 PROVIDER ENROLLMENT
INDIANAPOLIS IN
46204-3908
US

V. Phone/Fax

Practice location:
  • Phone: 317-216-2700
  • Fax: 317-216-2777
Mailing address:
  • Phone: 317-962-4945
  • Fax: 317-962-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number01033717
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: