Provider Demographics
NPI:1467064865
Name:KRISELL D. FEDRIZZI, D.O.
Entity Type:Organization
Organization Name:KRISELL D. FEDRIZZI, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FEDRIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-974-9716
Mailing Address - Street 1:325 N MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8005
Mailing Address - Country:US
Mailing Address - Phone:937-949-4713
Mailing Address - Fax:855-460-5802
Practice Address - Street 1:325 N MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-8005
Practice Address - Country:US
Practice Address - Phone:937-949-4713
Practice Address - Fax:855-460-5802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty