Provider Demographics
NPI:1396710232
Name:FRITZEN, ROBERT D (EDD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:FRITZEN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12809 S SAGINAW ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2416
Mailing Address - Country:US
Mailing Address - Phone:810-695-1588
Mailing Address - Fax:
Practice Address - Street 1:12809 S SAGINAW ST
Practice Address - Street 2:SUITE 114
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2416
Practice Address - Country:US
Practice Address - Phone:810-695-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001619103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680B545140OtherBC/BS
MI620B545140OtherHEALTH PLUS OF MI
MI0B54514Medicare ID - Type UnspecifiedMENTAL HEALTH