MEDICARE: DR. KRISELL D FEDRIZZI 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	34004949F	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080191722	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	34004949F	OTHER	OH	MEDICAL LICENSE
3	000000227847	OTHER	OH	ANTHEM
4	0120677	OTHER	OH	UNITED HEALTHCARE
5	649246	OTHER	OH	AETNA
6	D0494904	OTHER	OH	HUMANACHOICECARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	421534506029	OTHER	OH	CARESOURCE

General Provider Information

NPI Number	:	1497757736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISELL D FEDRIZZI D.O.

Provider Business Mailing Address
First Line	:	PO BOX 194
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-0194
Country	:	US
Telephone Number	:	937-949-4713
Fax Number	:	855-460-5802

Provider Business Practice Location Address
First Line	:	325 N MAIN ST STE 206
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-8005
Country	:	US
Telephone Number	:	937-949-4713
Fax Number	:	855-460-5802

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/03/2024

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Directions to “ DR. KRISELL D FEDRIZZI D.O.” Practice Location

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