Individual
DR. MARK A FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3299 CLEAR VISTA CT NE, SUITE C, GRAND RAPIDS, MI 49525
(616) 361-1200
(616) 361-2198
Mailing address
5514 PRESERVE CT, BELMONT, MI 49306-8510
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MF048876
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080D148480
BCBS MICH
—
05
—
2836516
—
MI
Enumeration date
10/26/2006
Last updated
10/08/2024
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