Individual
PAUL FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
02957 73RD ST, SOUTH HAVEN, MI 49090-9364
(269) 637-9099
(269) 637-9224
Mailing address
02957 73RD ST, SOUTH HAVEN, MI 49090-9364
(269) 637-9099
(269) 637-9224
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
M15501011004
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4800853
—
MI
01
—
OHO1023
BLUE CROSS BLUE SHIELD
MI
Enumeration date
09/15/2006
Last updated
03/20/2008
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