Provider Demographics
NPI:1497757736
Name:FEDRIZZI, KRISELL D (DO)
Entity type:Individual
Prefix:DR
First Name:KRISELL
Middle Name:D
Last Name:FEDRIZZI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-0194
Mailing Address - Country:US
Mailing Address - Phone:937-949-4713
Mailing Address - Fax:855-460-5802
Practice Address - Street 1:325 N MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-8005
Practice Address - Country:US
Practice Address - Phone:937-949-4713
Practice Address - Fax:855-460-5802
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004949F207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080191722OtherRAILROAD MEDICARE
OH34004949FOtherMEDICAL LICENSE
OH000000227847OtherANTHEM
OH0120677OtherUNITED HEALTHCARE
OH649246OtherAETNA
OHD0494904OtherHUMANACHOICECARE
OH0769726Medicaid
OH421534506029OtherCARESOURCE
OH0769726Medicaid
OH000000227847OtherANTHEM