Individual
MARILYNN E FREDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-7956
Mailing address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-7956
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
36058725
IL
207VM0101X
Maternal & Fetal Medicine Physician
Primary
68138
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071887
—
WI
01
—
1627904
BLUE CROSS/BLUE SHIELD NO
IL
Enumeration date
07/21/2005
Last updated
09/04/2019
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