Provider Demographics
NPI:1558723262
Name:FREILICH, ADAM (DO)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:FREILICH
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 1:304 S JONES BLVD # 884
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2623
Mailing Address - Country:US
Mailing Address - Phone:702-900-4085
Mailing Address - Fax:844-750-0677
Practice Address - Street 1:304 S JONES BLVD # 884
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2623
Practice Address - Country:US
Practice Address - Phone:702-900-4085
Practice Address - Fax:844-750-0677
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2801207L00000X
PAOT020081390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250012117Medicaid