Fredrick H Wallisch, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01059213A Issued in IN

Practice address

515 Read St
Evansville, IN 47710-1739

Phone

(812) 450-3363

Fax

(812) 450-3071

NPI assigned

Mar 23, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Robert Farmer MD SC

  • Family Medicine Physician
  • New Baden, IL
  • NPI 1013101211
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410739200000",
    "number": "1528027950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3407",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477333407",
            "telephone_number": "812-450-3363",
            "fax_number": "812-450-3071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 READ ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101739",
            "telephone_number": "812-450-3363",
            "fax_number": "812-450-3071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLISCH",
        "first_name": "FREDRICK",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2014-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01059213A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00315732",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200042820",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia G Wallace, CNS
• Cameron Bradley Waller, DO
• Charlotte Waller, LMHC
• James D Waller Jr., MD
• Sherri A Walling, NP
• Jenna Marie Walls, COTA
• Ryan C Walls, CRNA
• Alexis Walser
• Albert L Walsh, MD
• Dalton Walsh

• Family Medicine Physician in Evansville, IN
• Providers in Evansville, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.