Provider Demographics
NPI:1912902404
Name:FRYZEK, ROBERT KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENNETH
Last Name:FRYZEK
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 1:14 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1739
Mailing Address - Country:US
Mailing Address - Phone:712-527-9135
Mailing Address - Fax:712-527-5679
Practice Address - Street 1:PO BOX 69
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-0069
Practice Address - Country:US
Practice Address - Phone:712-527-9135
Practice Address - Fax:712-527-5679
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0033670Medicaid
IAA00455Medicare UPIN
IA0033670Medicaid