MEDICARE: MICHAEL D FRYAR FNP

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
1	363LF0000X	Family Nurse Practitioner	30795	TN

General Provider Information

NPI Number	:	1578229373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D FRYAR FNP

Provider Business Mailing Address
First Line	:	PO BOX 3877
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60434-3877
Country	:	US
Telephone Number	:	815-714-7171
Fax Number	:	815-435-5080

Provider Business Practice Location Address
First Line	:	1060 PEERLESS XING NW STE 101
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3785
Country	:	US
Telephone Number	:	423-339-3340
Fax Number	:	423-339-9927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	02/10/2026

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