Provider Demographics
NPI:1336449172
Name:FRISCH, MICKEL
Entity Type:Individual
Prefix:
First Name:MICKEL
Middle Name:
Last Name:FRISCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MIKE'S
Other - Middle Name:MOBILE
Other - Last Name:REPAIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:395 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:MN
Mailing Address - Zip Code:55952-1109
Mailing Address - Country:US
Mailing Address - Phone:507-459-4830
Mailing Address - Fax:
Practice Address - Street 1:395 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:MN
Practice Address - Zip Code:55952-1109
Practice Address - Country:US
Practice Address - Phone:507-459-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies