Provider Demographics
NPI:1518934553
Name:FRYLING, MALIWAN KOSITANON (MD)
Entity Type:Individual
Prefix:DR
First Name:MALIWAN
Middle Name:KOSITANON
Last Name:FRYLING
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 1:2200 BERGQUIST DRIVE,SUITE 1
Mailing Address - Street 2:LACKLAND AFB
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5300
Mailing Address - Country:US
Mailing Address - Phone:210-925-6336
Mailing Address - Fax:210-925-1127
Practice Address - Street 1:204 PAUL WAGNER DR
Practice Address - Street 2:
Practice Address - City:KELLY USA
Practice Address - State:TX
Practice Address - Zip Code:78241
Practice Address - Country:US
Practice Address - Phone:210-925-6336
Practice Address - Fax:210-925-1127
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine