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NPI Code Detail

MEDICARE: DR. BRADLEY ROBERT FREIDEL D.O.

MEDICARE: DR. BRADLEY ROBERT FREIDEL D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician324NE

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5P00128031OTHERMTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
107035OTHERNEBLUE CROSS PROVIDER #
220065242968066OTHERNETRICARE PROVIDER
3235966OTHERNEMIDLANDS CHOICE
4200652429OTHERNEUNITED HEALTHCARE
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184744765
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY ROBERT FREIDEL D.O.
Provider Business Mailing Address
First Line : 1201 N RUTHERFORD ST
Second Line :
City : MACON
State : MO
Zip : 63552-2020
Country : US
Telephone Number : 660-385-8900
Fax Number : 660-385-8708
Provider Business Practice Location Address
First Line : 1201 N RUTHERFORD ST
Second Line :
City : MACON
State : MO
Zip : 63552-2020
Country : US
Telephone Number : 660-385-8900
Fax Number : 660-385-8708
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 01/10/2013

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