Provider Demographics
NPI:1083891675
Name:FRIESSEN, ANDREW JOHN (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:FRIESSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3453
Mailing Address - Country:US
Mailing Address - Phone:563-264-9185
Mailing Address - Fax:
Practice Address - Street 1:1616 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3453
Practice Address - Country:US
Practice Address - Phone:563-264-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016427207X00000X
IADO-4433207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1083891675Medicaid
IAP01375680OtherRR MEDICARE
IAIB2621043Medicare PIN