Provider Demographics
NPI:1598754558
Name:FROUGE, THREASA H (MD)
Entity Type:Individual
Prefix:
First Name:THREASA
Middle Name:H
Last Name:FROUGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THREASA
Other - Middle Name:H
Other - Last Name:REIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2323 W ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2530
Mailing Address - Country:US
Mailing Address - Phone:623-931-7999
Mailing Address - Fax:623-842-5640
Practice Address - Street 1:5605 W EUGIE AVE STE 110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1273
Practice Address - Country:US
Practice Address - Phone:623-847-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ176702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ276784Medicaid
D86747Medicare UPIN
AZZ128229Medicare PIN
AZ276784Medicaid
AZ30WCFHS18Medicare PIN