Individual
MICHAEL FREDERICSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 BLAKE WILBUR DR, FIRST FLOOR MC 5311, PALO ALTO, CA 94304-2201
(650) 725-7139
(650) 498-7546
Mailing address
300 PASTEUR DR, EDWARDS R105 MC 5341, STANFORD, CA 94305-2200
(650) 725-7139
(650) 498-7546
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
G67096
CA
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
G67096
CA
Other
Enumeration date
01/26/2007
Last updated
05/06/2024
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