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Individual

FREDERICK P JAECKLEIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1414 W. FAIR AVENUE, STE 201, MARQUETTE, MI 49855
(906) 225-4500
(906) 225-3919
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7000
(916) 920-8775

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
049842
MI
207RH0000X
Hematology (Internal Medicine) Physician
049842
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
110030846
RAILROAD MEDICARE
MI
05
3138366
MI
01
381358036011
TRICARE
MI
Enumeration date
11/17/2005
Last updated
06/04/2019
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