Individual
DR. MICHAEL EDWIN FREDERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4371 E LOHMAN AVE, LAS CRUCES, NM 88011-8255
(575) 532-8900
(575) 532-8910
Mailing address
4371 E LOHMAN AVE, LAS CRUCES, NM 88011-8255
(575) 532-8900
(575) 532-8910
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
22879
WV
207Q00000X
Family Medicine Physician
G84864
CA
207Q00000X
Family Medicine Physician
Primary
MD2009-0731
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009924
—
WV
Enumeration date
06/23/2006
Last updated
09/18/2020
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