Provider Demographics
NPI:1336129352
Name:FRALICH, TODD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALLEN
Last Name:FRALICH
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 1:6405 N FEDERAL HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1412
Mailing Address - Country:US
Mailing Address - Phone:954-772-2411
Mailing Address - Fax:954-772-3766
Practice Address - Street 1:6405 N FEDERAL HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1412
Practice Address - Country:US
Practice Address - Phone:954-772-2411
Practice Address - Fax:954-772-3766
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH02565Medicare UPIN
FL47118AMedicare ID - Type Unspecified