Basic Information
| Provider Information | |||||||||
| NPI: | 1457778698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRITSCH | ||||||||
| FirstName: | JENNA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 W MICHIGAN ST | ||||||||
| Address2: | # FH204 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172740076 | ||||||||
| FaxNumber: | 3172740256 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 SOUTH DR | ||||||||
| Address2: | FESLER HALL 204 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172740076 | ||||||||
| FaxNumber: | 3172740256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2014 | ||||||||
| LastUpdateDate: | 01/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 0810264507 | IN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 11018100A | IN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.