Provider Demographics
NPI:1386636272
Name:FREITAG, FREDERICK (DO)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:FREITAG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-260-2900
Mailing Address - Fax:608-260-3444
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-260-2900
Practice Address - Fax:608-260-3444
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI59956207Q00000X, 208VP0000X
TXN6870207Q00000X, 208VP0000X
WI59956-212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218029101Medicaid
WI1386636272Medicaid
TX8CL774OtherBCBSTX
TX218029102Medicaid
WI68086 2731Medicare PIN
TX8CL774OtherBCBSTX
WI1386636272Medicaid
TXTXB117857Medicare PIN
TXP01025594Medicare PIN
ILP05998Medicare PIN
TXTXB117859Medicare PIN
TXTXB111543Medicare PIN