Basic Information
| Provider Information | |||||||||
| NPI: | 1417282138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREIDEL | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593445555 | ||||||||
| FaxNumber: | 8593445552 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 BRIDGEWAY ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470011378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124968785 | ||||||||
| FaxNumber: | 8129260431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2009 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34.010082 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 03505 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 02005609A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 300022617 | 05 | IN | MEDICAID |