MEDICARE: ANDREA FRALEY MD

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	208100000X	Physical Medicine & Rehabilitation Physician	26519	OK
2	208100000X	Physical Medicine & Rehabilitation Physician	036-115728	IL
3	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	26519	OK

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	:	1487660585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA FRALEY MD

Provider Business Mailing Address
First Line	:	925 W I 35 FRONTAGE RD STE 100
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-7399
Country	:	US
Telephone Number	:	405-471-5460
Fax Number	:	405-471-6513

Provider Business Practice Location Address
First Line	:	2017 W I 35 FRONTAGE RD
Second Line	:	SUITE 130
City	:	EDMOND
State	:	OK
Zip	:	73013-8504
Country	:	US
Telephone Number	:	405-757-3630
Fax Number	:	405-757-3631

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	01/11/2018

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Directions to “ ANDREA FRALEY MD” Practice Location

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