Basic Information
| Provider Information | |||||||||
| NPI: | 1093744120 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FROELICH | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | WALTER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE ST SE | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS, MMC 292 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126263345 | ||||||||
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| Practice Location | |||||||||
| Address1: | 516 DELAWARE ST SE | ||||||||
| Address2: | UNIV.OF MN PHYSICIANS, PWB FIRST FLOOR, CLINIC 1D | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122736004 | ||||||||
| FaxNumber: | 6122738459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | 44437 | MN | X | Allopathic & Osteopathic Physicians | Nuclear Medicine | 2085R0202X | 44437 | MN | X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | HP34061 | 01 | MN | HEALTHPARTNERS | OTHER | 236323 | 01 | MN | ARAZ | OTHER | 10387 | 05 | ND | MEDICAID | 0571968 | 05 | IA | MEDICAID | 0068000 | 05 | MT | MEDICAID | 1029764 | 01 | MN | PREFERRED ONE | OTHER | 16-02032 | 01 | MN | MEDICA PRIMARY | OTHER | 16-02745 | 01 | MN | MEDICA CHOICE | OTHER | 170259 | 01 | MN | UCARE | OTHER | 7777470 | 05 | SD | MEDICAID |