Healthcare Provider Details

I. General information

NPI: 1659424810
Provider Name (Legal Business Name): BRADLEY LAWRENCE FREILICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 HOLMES RD STE 430
KANSAS CITY MO
64131-1167
US

IV. Provider business mailing address

6675 HOLMES RD STE 430
KANSAS CITY MO
64131-1167
US

V. Phone/Fax

Practice location:
  • Phone: 816-361-5525
  • Fax: 816-361-5775
Mailing address:
  • Phone: 816-361-5525
  • Fax: 816-361-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number106564
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: