Provider Demographics
NPI:1184689333
Name:MOISE, FRITZ (MD)
Entity type:Individual
Prefix:
First Name:FRITZ
Middle Name:
Last Name:MOISE
Suffix:
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 1:200 WAKEFIELD TRCE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5143
Mailing Address - Country:US
Mailing Address - Phone:502-774-4401
Mailing Address - Fax:
Practice Address - Street 1:200 WAKEFIELD TRCE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5143
Practice Address - Country:US
Practice Address - Phone:502-245-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00449265OtherRRMCR
KY200107170OtherHEALTHY INDIANA PLAN- NORTON IMMEDIATE CARE CENTER
KY200107170OtherMD WISE- NORTON IMMEDIATE CARE CENTER
KY000000381974OtherANTHEM FOR NICC
IN200107170Medicaid
IN200107170OtherANTHEM INDIANA MEDICAID- NORTON ICC
F72362Medicare UPIN
KY200107170OtherHEALTHY INDIANA PLAN- NORTON IMMEDIATE CARE CENTER
IN196290GGMedicare PIN