Individual
FREDERICK W UNVERZAGT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
550 UNIVERSITY BLVD # UH3124, INDIANAPOLIS, IN 46202-5149
(317) 274-1250
Mailing address
250 N SHADELAND AVE STE 200, INDIANAPOLIS, IN 46219-4959
(317) 962-3834
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20040645A
IN
2084N0600X
Clinical Neurophysiology Physician
20040645
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100195770
—
IN
Enumeration date
05/19/2006
Last updated
11/23/2020
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