Provider Demographics
NPI:1518051358
Name:COLON AND RECTAL SURGERY ASSOCIATES PC
Entity Type:Organization
Organization Name:COLON AND RECTAL SURGERY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT OF CORP
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:DIETER
Authorized Official - Last Name:FRIEDL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-343-0445
Mailing Address - Street 1:1126 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048
Mailing Address - Country:US
Mailing Address - Phone:269-343-0740
Mailing Address - Fax:269-343-0715
Practice Address - Street 1:1126 GULL RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048
Practice Address - Country:US
Practice Address - Phone:269-343-0740
Practice Address - Fax:269-343-0715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C96122Medicare PIN