Provider Demographics
NPI:1417282138
Name:FREIDEL, PATRICIA (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:FREIDEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:107 BRIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-1378
Practice Address - Country:US
Practice Address - Phone:812-496-8785
Practice Address - Fax:812-926-0431
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010082207R00000X
KY03505207R00000X
IN02005609A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300022617Medicaid