Healthcare Provider Details

I. General information

NPI: 1952750549
Provider Name (Legal Business Name): JOSHUA FREDERICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 SOUTH MADISON RD
BELOIT WI
53511-1972
US

IV. Provider business mailing address

1969 WEST HART RD
BELOIT WI
53511
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-7510
  • Fax: 317-338-7494
Mailing address:
  • Phone: 608-364-5689
  • Fax: 608-364-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11018931A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11018931A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: