Provider Demographics
NPI:1649703752
Name:FRIEDRICH, FRED THOMAS
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:THOMAS
Last Name:FRIEDRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-1309
Mailing Address - Country:US
Mailing Address - Phone:515-709-5781
Mailing Address - Fax:
Practice Address - Street 1:1824 BENTON ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-1309
Practice Address - Country:US
Practice Address - Phone:515-709-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide