Individual
THADDEUS CARL FRICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
200 PATEWOOD DR, SUITE C100, GREENVILLE, SC 29615-3593
(864) 454-7422
(864) 454-8265
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
915
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0449PA
—
SC
01
—
P00847276
RAILROAD MEDICARE
SC
Enumeration date
05/12/2006
Last updated
08/02/2013
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