Provider Demographics
NPI:1023171907
Name:FROELICH, THOMAS MARTIN (MS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARTIN
Last Name:FROELICH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58704
Mailing Address - Country:US
Mailing Address - Phone:701-858-3030
Mailing Address - Fax:701-858-3032
Practice Address - Street 1:500 UNIVERSITY AVENUE WEST
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58704
Practice Address - Country:US
Practice Address - Phone:701-858-3030
Practice Address - Fax:701-858-3032
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND237231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDFRO5161OtherBCBS
ND59893Medicaid