Healthcare Provider Details

I. General information

NPI: 1588668404
Provider Name (Legal Business Name): STEVEN L FRIESEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 CLAREMONT AVE
ASHLAND OH
44805-3533
US

IV. Provider business mailing address

1522 CLAREMONT AVE
ASHLAND OH
44805-3533
US

V. Phone/Fax

Practice location:
  • Phone: 419-207-1085
  • Fax: 419-207-0607
Mailing address:
  • Phone: 419-207-1085
  • Fax: 419-207-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35079410
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: