Provider Demographics
NPI:1720183353
Name:FREYDL, KARL ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:ROBERT
Last Name:FREYDL
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 1:46325 W 12 MILE RD.
Mailing Address - Street 2:STE. 100
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:877-784-3667
Mailing Address - Fax:248-869-3982
Practice Address - Street 1:29275 NORTHWESTERN HWY
Practice Address - Street 2:STE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:877-784-3667
Practice Address - Fax:248-869-3982
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015444208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5811183OtherBCBS OF MI PIN
MI2335426OtherUNITED HEALTH CARE NO
MI1720183353OtherBCN
MI50146067OtherHAP
MI140164OtherCARE CHOICE INDIVIDUAL NO
MI7876357OtherAETNA INDIVIDUAL NO
MI2335426OtherUNITED HEALTH CARE NO
MIN77130004Medicare ID - Type UnspecifiedMEDICARE-99 LOCALITY
MIH02657Medicare UPIN