Provider Demographics
NPI:1740381508
Name:FRITCH, HOLLY (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:FRITCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:FRITCH KIRBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11201 NALL AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1669
Mailing Address - Country:US
Mailing Address - Phone:913-451-3030
Mailing Address - Fax:
Practice Address - Street 1:11201 NALL AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1669
Practice Address - Country:US
Practice Address - Phone:913-451-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18382207N00000X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE08136Medicare UPIN
KS0000227AMedicare PIN