Healthcare Provider Details

I. General information

NPI: 1215961743
Provider Name (Legal Business Name): MICHAEL H FRITSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9002 N MERIDIAN ST SUITE 204
INDIANAPOLIS IN
46260-5381
US

IV. Provider business mailing address

9002 N MERIDIAN ST SUITE 204
INDIANAPOLIS IN
46260-5381
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-9505
  • Fax: 317-848-3623
Mailing address:
  • Phone: 317-848-9505
  • Fax: 317-848-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number01035973A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: