=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851330112
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WALTER E FRITZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2006
-----------------------------------------------------
Last Update Date | 10/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 S EDGEWOOD DR
-----------------------------------------------------
City | KNOX
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46534-8226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-772-2188
-----------------------------------------------------
Fax | 574-772-2190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1002 S EDGEWOOD DR
-----------------------------------------------------
City | KNOX
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46534-8226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-772-2188
-----------------------------------------------------
Fax | 574-772-2190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 01024309A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------