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Individual

FREDRICK H WALLISCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
515 READ ST, EVANSVILLE, IN 47710-1739
(812) 450-3363
(812) 450-3071
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 450-3363
(812) 450-3071

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01059213A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200042820
IN
01
P00315732
RR MEDICARE
IN
Enumeration date
03/23/2006
Last updated
09/15/2014
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