Demetrius Frierson
Individual provider Active NPI Contractor · Indianapolis, IN
NPI 1093494585 · NPPES record last updated Jul 18, 2023
Key facts
- NPI
- 1093494585
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 7098 N Shadeland Ave Ste F
Indianapolis, IN 46220-4275 - Phone
- (317) 771-3006
- NPI assigned
- Jul 13, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Identity Outreach Program Corp. | Current |
Accepting new patients |
Locations
7098 N Shadeland Ave
Ste F
Indianapolis, IN 46220
Phone (317) 771-3006
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
7098 N Shadeland Ave Ste F
Indianapolis, IN 46220-4275
Mailing address
7098 N Shadeland Ave Ste F
Indianapolis, IN 46220-4275
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.