Provider Demographics
NPI:1356364913
Name:FRAIFOGL, ANGELA LYNN (DPM)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:FRAIFOGL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 CLEVELAND RD W UNIT F
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-2901
Mailing Address - Country:US
Mailing Address - Phone:419-433-4800
Mailing Address - Fax:419-433-4833
Practice Address - Street 1:2012 CLEVELAND RD W UNIT F
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-2901
Practice Address - Country:US
Practice Address - Phone:419-433-4800
Practice Address - Fax:419-433-4833
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3389213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU95709Medicare UPIN
OHFR4147181Medicare ID - Type Unspecified