Provider Demographics
NPI:1457457079
Name:FRECHEN, HENRY J (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:J
Last Name:FRECHEN
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 1:51862 DOWNEY ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-5950
Mailing Address - Country:US
Mailing Address - Phone:574-264-4094
Mailing Address - Fax:
Practice Address - Street 1:2120 RIETH BLVD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5843
Practice Address - Country:US
Practice Address - Phone:574-875-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01085834A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE18006Medicare UPIN