Provider Demographics
NPI:1821028515
Name:FRIESEN, KERRY D (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:D
Last Name:FRIESEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7030 LEE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6795
Mailing Address - Country:US
Mailing Address - Phone:423-553-9995
Mailing Address - Fax:423-553-9966
Practice Address - Street 1:7030 LEE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6795
Practice Address - Country:US
Practice Address - Phone:423-553-9995
Practice Address - Fax:423-553-9966
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN27073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3094857Medicare PIN
TNF89044Medicare UPIN