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General NPI Number Information
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NPI Number | 1104090265
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Entity Type | Individual
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Provider Name | TRACI RENAE FRITZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 6100 W STATE ST APT 404
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City | WAUWATOSA
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State | WI
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Zip | 53213-2994
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Country | US
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Telephone | 254-485-9570
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Fax | 414-475-7706
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Provider Business Mailing Address
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Address Line | 6100 W STATE ST APT 404
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City | WAUWATOSA
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State | WI
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Zip | 53213-2994
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Country | US
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Telephone | 254-485-9570
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Fax | 414-475-7706
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 64874
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License Number State | WI
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