Provider Demographics
NPI:1184626475
Name:HORWITZ, S. FREDRIC I (MD)
Entity type:Individual
Prefix:
First Name:S. FREDRIC
Middle Name:
Last Name:HORWITZ
Suffix:I
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 1:2350 W VILLARD AVE
Mailing Address - Street 2:# 207
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5086
Mailing Address - Country:US
Mailing Address - Phone:414-527-9800
Mailing Address - Fax:414-527-9803
Practice Address - Street 1:2350 W VILLARD AVE
Practice Address - Street 2:# 207
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5086
Practice Address - Country:US
Practice Address - Phone:414-527-9800
Practice Address - Fax:414-527-9803
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIME14689207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31156700Medicaid
WIB53699Medicare UPIN