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General NPI Number Information
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NPI Number | 1518051358
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Entity Type | Organization
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Legal Business Name | COLON AND RECTAL SURGERY ASSOCIATES PC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 11/11/2007
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Provider Practice Location Address
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Address Line | 1126 GULL RD
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City | KALAMAZOO
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State | MI
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Zip | 49048
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Country | US
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Telephone | 269-343-0740
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Fax | 269-343-0715
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Provider Business Mailing Address
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Address Line | 1126 GULL RD
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City | KALAMAZOO
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State | MI
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Zip | 49048
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Country | US
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Telephone | 269-343-0740
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Fax | 269-343-0715
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Authorized Official
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Title or Position | OWNER PRESIDENT OF CORP
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Name | HAROLD DIETER FRIEDL
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Credential | MD
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Telephone | 269-343-0445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State | MI
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