Provider Demographics
NPI:1194941708
Name:FRENTZ, NATALIE JOY (MD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JOY
Last Name:FRENTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:JOY
Other - Last Name:VANDEVENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6301 UNIVERSITY COMMONS
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1571
Mailing Address - Country:US
Mailing Address - Phone:574-234-4016
Mailing Address - Fax:574-239-4607
Practice Address - Street 1:6301 UNIVERSITY COMMONS
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1571
Practice Address - Country:US
Practice Address - Phone:574-234-4016
Practice Address - Fax:574-239-4607
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063651A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200863040Medicaid
IN245510D3Medicare PIN