Basic Information
| Provider Information | |||||||||
| NPI: | 1487604229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRISCH | ||||||||
| FirstName: | MELVIN | ||||||||
| MiddleName: | JULIUS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 NICOLLET MALL | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554022500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123332503 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 801 NICOLLET MALL | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554022500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123332503 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 17719 | MN | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | HP13321 | 01 | MN | HEALTH PARTNERS | OTHER | 768553 | 01 | MN | AMERICA'S PPO | OTHER | FP9040284017 | 01 | MN | PREFERRED ONE | OTHER | 0700065 | 01 | MN | MEDICA DUAL/MEDICARE MA | OTHER | 0704100 | 01 | MN | MEDICA | OTHER | 31355400 | 05 | WI | MEDICAID | 379L2FR | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER |