Provider Demographics
NPI:1164754271
Name:FRITZ, DANIEL JOHN (CSA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:FRITZ
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:WANAMINGO
Mailing Address - State:MN
Mailing Address - Zip Code:55983-3414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-266-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1482OtherNATIONAL SURGICAL ASSISTANT ASSOCIATION