Basic Information
Provider Information
NPI: 1912968439
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRITSCH
FirstName: MICHAEL
MiddleName: K
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7974 UW HEALTH CT
Address2:  
City: MIDDLETON
State: WI
PostalCode: 535625531
CountryCode: US
TelephoneNumber: 6088295485
FaxNumber:  
Practice Location
Address1: 600 HIGHLAND AVE
Address2:  
City: MADISON
State: WI
PostalCode: 537924546
CountryCode: US
TelephoneNumber: 6082638437
FaxNumber: 6088336932
Other Information
ProviderEnumerationDate: 04/01/2006
LastUpdateDate: 01/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0105X27971WIY Allopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine

No ID Information.


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