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NPI Code Detail

MEDICARE: KELLY FRIEDMEYER

MEDICARE:   KELLY  FRIEDMEYER
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
1374700000XTechnician

General Provider Information

NPI Number : 1477129005
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY FRIEDMEYER
Provider Business Mailing Address
First Line : 227 MAIN ST
Second Line :
City : FESTUS
State : MO
Zip : 63028-1952
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 324 EMERSON ROAD
Second Line :
City : HIGH RIDGE
State : MO
Zip : 63049-2542
Country : US
Telephone Number : 636-677-9977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2021
Last Update Date : 06/03/2021

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Directions to “ KELLY FRIEDMEYER ” Practice Location

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