Provider Demographics
NPI:1912327644
Name:FRYDENLUND, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:FRYDENLUND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 CLAY EDWARDS DR STE 600
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3258
Mailing Address - Country:US
Mailing Address - Phone:816-453-4000
Mailing Address - Fax:816-842-1486
Practice Address - Street 1:2750 CLAY EDWARDS DR STE 600
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3258
Practice Address - Country:US
Practice Address - Phone:816-453-4000
Practice Address - Fax:816-842-1486
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61534207T00000X, 208600000X
MO2020021948208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program