Provider Demographics
NPI:1407879653
Name:FRIAR, KIMBERLY R (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:FRIAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1629
Mailing Address - Country:US
Mailing Address - Phone:517-543-1050
Mailing Address - Fax:517-541-5870
Practice Address - Street 1:123 LANSING ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1696
Practice Address - Country:US
Practice Address - Phone:517-543-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKJ068519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000002175OtherPHP
MI0803305452OtherBLUE CROSS BLUE SHIELD
MI4149293Medicaid
080147795OtherRAILROAD MEDICARE
MI200000002175OtherPHP
MIH05848Medicare UPIN