Provider Demographics
NPI:1295776714
Name:MITZEL, FREDRICK (MD)
Entity type:Individual
Prefix:
First Name:FREDRICK
Middle Name:
Last Name:MITZEL
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 1:401 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4247
Mailing Address - Country:US
Mailing Address - Phone:701-253-5300
Mailing Address - Fax:701-253-5402
Practice Address - Street 1:1000 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3250
Practice Address - Country:US
Practice Address - Phone:701-845-8060
Practice Address - Fax:701-845-8067
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15381Medicaid
ND939371OtherARAZ #
NDHP23755OtherHEALTHPARTNERS #
ND596822400Medicaid
ND0121791OtherVALLEY CITY MEDICA #
ND137121OtherUCARE #
ND323S8MIOtherMNBS #
ND26265OtherNDBS VC #
NDDA9061014591OtherVALLEY CITY PREF 1 #
ND45611OtherLHS #
ND0121791OtherVALLEY CITY MEDICA #
ND26265OtherNDBS VC #
NDDA9061014591OtherVALLEY CITY PREF 1 #