Individual
JOHN J FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3346 LENNON RD, SUITE 2, FLINT, MI 48507-1082
(810) 732-1919
(810) 732-3740
Mailing address
3346 LENNON ROAD, SUITE 2, FLINT, MI 48507-1015
(810) 732-1919
(810) 732-3740
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5101007568
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300075605
RAILROAD MEDICARE
MI
01
—
310B510660
BCBSM
MI
05
—
3321207
—
MI
Enumeration date
06/26/2006
Last updated
08/23/2011
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