Healthcare Provider Details

I. General information

NPI: 1932188331
Provider Name (Legal Business Name): DAWES FRETZIN DERMATOLOGY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 N SHADELAND AVE
INDIANAPOLIS IN
46250-2041
US

IV. Provider business mailing address

7910 N SHADELAND AVE
INDIANAPOLIS IN
46250-2041
US

V. Phone/Fax

Practice location:
  • Phone: 317-516-5000
  • Fax: 317-516-5146
Mailing address:
  • Phone: 317-516-5000
  • Fax: 317-516-5146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT ALFRED FRETZIN
Title or Position: MEMBER
Credential: M.D.
Phone: 317-516-5000