Provider Demographics
NPI:1184689333
Name:MOISE, FRITZ (MD)
Entity Type:Individual
Prefix:
First Name:FRITZ
Middle Name:
Last Name:MOISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1969
Mailing Address - Country:US
Mailing Address - Phone:502-774-4401
Mailing Address - Fax:502-772-4783
Practice Address - Street 1:3015 WILSON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1969
Practice Address - Country:US
Practice Address - Phone:502-774-4401
Practice Address - Fax:502-772-4783
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY200107170OtherMD WISE- NORTON IMMEDIATE CARE CENTER
IN200107170OtherANTHEM INDIANA MEDICAID- NORTON ICC
KY200107170OtherHEALTHY INDIANA PLAN- NORTON IMMEDIATE CARE CENTER
KY000000381974OtherANTHEM FOR NICC
IN200107170Medicaid
KYP00449265OtherRRMCR
F72362Medicare UPIN
KY200107170OtherHEALTHY INDIANA PLAN- NORTON IMMEDIATE CARE CENTER
IN196290GGMedicare PIN