MEDICARE: DR. FREDERICK FREITAG 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	207Q00000X	Family Medicine Physician	59956	WI
2	207Q00000X	Family Medicine Physician	N6870	TX
3	2084N0400X	Neurology Physician	59956-21	WI
4	208VP0000X	Pain Medicine Physician	N6870	TX
5	208VP0000X	Pain Medicine Physician	59956	WI

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
3	8CL774	OTHER	TX	BCBSTX
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386636272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK FREITAG D.O.

Provider Business Mailing Address
First Line	:	700 S PARK ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53715-1830
Country	:	US
Telephone Number	:	608-260-2900
Fax Number	:	608-260-3444

Provider Business Practice Location Address
First Line	:	700 S PARK ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53715-1830
Country	:	US
Telephone Number	:	608-260-2900
Fax Number	:	608-260-3444

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	11/14/2024

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Directions to “ DR. FREDERICK FREITAG D.O.” Practice Location

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