Provider Demographics
NPI:1851330112
Name:FRITZ, WALTER E (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:E
Last Name:FRITZ
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 1:1002 S EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-8226
Mailing Address - Country:US
Mailing Address - Phone:574-772-2188
Mailing Address - Fax:574-772-2190
Practice Address - Street 1:1002 S EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-8226
Practice Address - Country:US
Practice Address - Phone:574-772-2188
Practice Address - Fax:574-772-2190
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024309A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000083056OtherBLUE CROSS PIN NUMBER
IN87-0778393OtherTAX IDENTIFICATION NUMBER
IN01024309AOtherWALTER FRITZ,M.D. LICENSE
IN200897290Medicaid
IN351301967OtherTAX ID
IN100225090AMedicaid
IN200020860AMedicaid
IN50000720AOtherCORPORATION LICENSE
INC25601Medicare UPIN
IN000000083056OtherBLUE CROSS PIN NUMBER
IN50000720AOtherCORPORATION LICENSE