MEDICARE: FRITZ DANIEL BRINK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	5101022720	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063862415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRITZ DANIEL BRINK D.O.

Provider Business Mailing Address
First Line	:	1501 PASADENA AVE S
Second Line	:
City	:	SOUTH PASADENA
State	:	FL
Zip	:	33707-3717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 PASADENA AVE S STE 3M
Second Line	:
City	:	SOUTH PASADENA
State	:	FL
Zip	:	33707-4563
Country	:	US
Telephone Number	:	586-576-4140
Fax Number	:	586-576-4146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2016
Last Update Date	:	08/31/2022

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