Provider Demographics
NPI:1134188006
Name:FRESE, DANIEL RAY (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RAY
Last Name:FRESE
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 1:604 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL GROVE
Mailing Address - State:KS
Mailing Address - Zip Code:66846-1422
Mailing Address - Country:US
Mailing Address - Phone:620-767-5126
Mailing Address - Fax:620-767-6910
Practice Address - Street 1:604 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COUNCIL GROVE
Practice Address - State:KS
Practice Address - Zip Code:66846-1422
Practice Address - Country:US
Practice Address - Phone:620-767-5126
Practice Address - Fax:620-767-6910
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0418380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS018651Medicare ID - Type Unspecified
KSD43125Medicare UPIN