MEDICARE: MS. AMY MARIE FRUEHWALD 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	207L00000X	Anesthesiology Physician	036137418	IL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207L00000X	Anesthesiology Physician	01084623B	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q00291745	OTHER	IN	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1255622247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY MARIE FRUEHWALD M.D.

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:	317-621-7912
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 E COUNTY LINE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46277-1447
Country	:	US
Telephone Number	:	317-887-7000
Fax Number	:

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

Provider Enumeration Date	:	04/25/2011
Last Update Date	:	07/15/2022

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