Individual
DR. JEFFREY HOWARD FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
30005 FOREST DR, FRANKLIN, MI 48025-1580
(248) 514-2604
Mailing address
30005 FOREST DR, FRANKLIN, MI 48025-1580
(248) 514-2604
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
JF001355
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1746737
—
MI
01
—
382791635
TAX ID
MI
01
—
4279750001
MEDICARE DME
MI
01
—
480005115
MEDICARE RAILROAD
—
01
—
485635446
BCBS
MI
01
—
DG9358
MEDICARE RAILROAD GROUP
—
Enumeration date
09/07/2006
Last updated
05/10/2023
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