Provider Demographics
NPI:1003524992
Name:FRISCH, PHILIP G (BS CHEMISTRY)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:G
Last Name:FRISCH
Suffix:
Gender:M
Credentials:BS CHEMISTRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3593 W LONG LAKE DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MI
Mailing Address - Zip Code:49274-9783
Mailing Address - Country:US
Mailing Address - Phone:419-601-3420
Mailing Address - Fax:
Practice Address - Street 1:1056 N OTTOKEE ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1900
Practice Address - Country:US
Practice Address - Phone:419-404-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA156F00000X
OH247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist