Provider Demographics
NPI:1497766679
Name:FRITZ, MELINDA S (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:S
Last Name:FRITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:S
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 N CLINTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-4611
Mailing Address - Country:US
Mailing Address - Phone:419-782-2147
Mailing Address - Fax:419-782-2157
Practice Address - Street 1:800 N CLINTON ST STE B
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-4611
Practice Address - Country:US
Practice Address - Phone:419-782-2147
Practice Address - Fax:419-782-2157
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064056A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN048580N6Medicare PIN