Provider Demographics
NPI:1215961743
Name:FRITSCH, MICHAEL H (MD)
Entity type:Individual
Prefix:PROF
First Name:MICHAEL
Middle Name:H
Last Name:FRITSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 N MERIDIAN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5381
Mailing Address - Country:US
Mailing Address - Phone:317-848-9505
Mailing Address - Fax:317-848-3623
Practice Address - Street 1:9002 N MERIDIAN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5381
Practice Address - Country:US
Practice Address - Phone:317-848-9505
Practice Address - Fax:317-848-3623
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035973A207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100085450Medicaid
INM3300019616OtherMEDICARE ID -TYPE UNSPECIFIED
INM3300019616OtherMEDICARE ID -TYPE UNSPECIFIED
INC43088Medicare UPIN