Provider Demographics
NPI:1972554475
Name:FRITSCH, WILLIAM J JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:FRITSCH
Suffix:JR
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 1:2525 DE SALES AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-495-2620
Mailing Address - Fax:423-495-2625
Practice Address - Street 1:2525 DE SALES AVENUE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-495-2620
Practice Address - Fax:423-495-2625
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115677207R00000X
TN52586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO144070OtherBCBS
458559OtherHEALTHLINK
010065855OtherRAILROAD MEDICARE
AR150941001Medicaid
KY64070030Medicaid
IL1972554475Medicaid
MO205881006Medicaid
AR150941001Medicaid
MO012013247Medicare PIN