Individual
DR. FREDERICK M MAYNARD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
580 W COLLEGE AVE, SKYWALK, MARQUETTE, MI 49855-2705
(906) 225-3914
(906) 225-4583
Mailing address
580 W COLLEGE AVE, SKYWALK, MARQUETTE, MI 49855-2705
(906) 225-3914
(906) 225-4583
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
028676
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250E26047
BLUE CROSS BLUE SHIELD MI
MI
05
—
4083530
—
MI
Enumeration date
10/04/2005
Last updated
10/18/2007
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