Provider Demographics
NPI:1336430255
Name:FRITZ, MARK ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:FRITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:740 S LIMESTONE B317 EAR NOSE & THROAT CLINIC
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-257-5405
Mailing Address - Fax:859-257-5096
Practice Address - Street 1:740 S LIMESTONE B317 EAR NOSE & THROAT CLINIC
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-6402
Practice Address - Country:US
Practice Address - Phone:859-257-5405
Practice Address - Fax:859-257-5096
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075637207Y00000X
390200000X
KY50115207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50115OtherKENTUCKY BOARD OF MEDICAL LICENSURE