Healthcare Provider Details

I. General information

NPI: 1063200434
Provider Name (Legal Business Name): BRADLEY J EDWARD FRERICKS CPRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8044 MONTGOMERY RD STE 120
CINCINNATI OH
45236-2919
US

IV. Provider business mailing address

8044 MONTGOMERY RD STE 120
CINCINNATI OH
45236-2919
US

V. Phone/Fax

Practice location:
  • Phone: 513-600-0693
  • Fax: 888-832-2040
Mailing address:
  • Phone: 513-600-0693
  • Fax: 888-832-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006133
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: