Provider Demographics
NPI:1659424810
Name:FREILICH, BRADLEY LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:LAWRENCE
Last Name:FREILICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 HOLMES RD STE 430
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1167
Mailing Address - Country:US
Mailing Address - Phone:816-361-5525
Mailing Address - Fax:816-361-5775
Practice Address - Street 1:6675 HOLMES RD STE 430
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1167
Practice Address - Country:US
Practice Address - Phone:816-361-5525
Practice Address - Fax:816-361-5775
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106564207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100166250BMedicaid
MO207735515Medicaid
MOE80205Medicare UPIN
MOL146495Medicare ID - Type Unspecified
KS100166250BMedicaid