Provider Demographics
NPI:1366466252
Name:FRIESER, RANDOLPH P (PT)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:P
Last Name:FRIESER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 W SCHILLER ST
Mailing Address - Street 2:APT 1601
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-4966
Mailing Address - Country:US
Mailing Address - Phone:312-878-8800
Mailing Address - Fax:
Practice Address - Street 1:222 MERCHANDISE MART PLZ
Practice Address - Street 2:SUITE 951
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-1103
Practice Address - Country:US
Practice Address - Phone:312-878-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070004684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL75458Medicare ID - Type UnspecifiedPERSONAL MEDICARE ID #
ILL75440Medicare ID - Type UnspecifiedPERSONAL MEDICARE ID #