Individual
DR. FREDRIC ALAN REYELTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 BROADWAY AVE NW STE 105, GRAND RAPIDS, MI 49504-4496
(616) 685-7500
(616) 785-7511
Mailing address
801 BROADWAY AVE NW STE 105, GRAND RAPIDS, MI 49504-4496
(616) 685-7500
(616) 685-7511
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301051511
MI
2084P0800X
Psychiatry Physician
4301051511
MI
2084P0805X
Geriatric Psychiatry Physician
4301051511
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2995094
—
MI
05
—
3415813
—
MI
05
—
4106189
—
MI
05
—
4155657
—
MI
05
—
4593050
—
MI
05
—
4593060
—
MI
05
—
4878865
—
MI
Enumeration date
05/18/2006
Last updated
06/07/2023
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