Provider Demographics
NPI:1144322249
Name:YOUNG, FREDRIC D (MD)
Entity type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3914
Mailing Address - Country:US
Mailing Address - Phone:219-924-3700
Mailing Address - Fax:219-924-3712
Practice Address - Street 1:1646 45TH AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3914
Practice Address - Country:US
Practice Address - Phone:219-924-3700
Practice Address - Fax:219-924-3712
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24515207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100197080AMedicaid
IN791183502Medicare PIN
IN387850Medicare PIN
INC24917Medicare UPIN
IN0472990001Medicare NSC