Healthcare Provider Details

I. General information

NPI: 1093744120
Provider Name (Legal Business Name): JERRY WALTER FROELICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 DELAWARE ST SE UNIV.OF MN PHYSICIANS, PWB FIRST FLOOR, CLINIC 1D
MINNEAPOLIS MN
55455-0356
US

IV. Provider business mailing address

420 DELAWARE ST SE UNIVERSITY OF MINNESOTA PHYSICIANS, MMC 292
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-6004
  • Fax: 612-273-8459
Mailing address:
  • Phone: 612-626-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number44437
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number44437
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: