MEDICARE: DR. ANGELA K AILES-FRICK M.D.

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	207Q00000X	Family Medicine Physician	35071655	OH
2	207Q00000X	Family Medicine Physician	41511	KY

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255334462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA K AILES-FRICK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1595
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41105-1595
Country	:	US
Telephone Number	:	606-408-5044
Fax Number	:	606-408-7425

Provider Business Practice Location Address
First Line	:	2001 SCIOTO TRL
Second Line	:	SUITE 100
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-2845
Country	:	US
Telephone Number	:	740-353-6390
Fax Number	:	740-353-6290

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/31/2011

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