Basic Information
| Provider Information | |||||||||
| NPI: | 1023346483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIESS | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | ELIA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3264 N EVERGREEN DR NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495259746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163537339 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 GUTHRIE SQ | ||||||||
| Address2: | |||||||||
| City: | SAYRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188401625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708874000 | ||||||||
| FaxNumber: | 5708875775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2009 | ||||||||
| LastUpdateDate: | 12/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | L1593670 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | OS017625 | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 279942 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.