MEDICARE: DR. GARY A FRICK DO

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	207RC0000X	Cardiovascular Disease Physician	02001087A	IN

General Provider Information

NPI Number	:	1326043571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY A FRICK DO

Provider Business Mailing Address
First Line	:	6920 POINTE INVERNESS WAY STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7934
Country	:	US
Telephone Number	:	260-479-3514
Fax Number	:	260-479-3520

Provider Business Practice Location Address
First Line	:	1123 N WESTERN AVE
Second Line	:
City	:	MARION
State	:	IN
Zip	:	46952-2501
Country	:	US
Telephone Number	:	765-651-9347
Fax Number	:	765-651-9346

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	09/23/2020

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