Basic Information
| Provider Information | |||||||||
| NPI: | 1386636272 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREITAG | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9200 W WISCONSIN AVE | ||||||||
| Address2: | DEPARTMENT OF NEUROLOGY | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148055200 | ||||||||
| FaxNumber: | 4142590469 | ||||||||
| Practice Location | |||||||||
| Address1: | 9200 W WISCONSIN AVE | ||||||||
| Address2: | DEPARTMENT OF NEUROLOGY | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148055200 | ||||||||
| FaxNumber: | 4142590469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 09/26/2013 | ||||||||
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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 | 208VP0000X | N6870 | TX | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207Q00000X | 59956 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | N6870 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 208VP0000X | 59956 | WI | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 218029101 | 05 | TX | MEDICAID | 8CL774 | 01 | TX | BCBSTX | OTHER | 1386636272 | 05 | WI | MEDICAID | 218029102 | 05 | TX | MEDICAID |