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Individual

TARA LEE FRERKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3916 N INTERTECH CT, APPLETON, WI 54913
(920) 996-1000
(920) 996-1054
Mailing address
3916 N INTERTECH CT, APPLETON, WI 54913-6957
(920) 996-1000
(920) 996-1054

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
32903
SC
207Q00000X
Family Medicine Physician
Primary
52283
WI
207QS0010X
Sports Medicine (Family Medicine) Physician
32903
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
32903
SC MEDICAL LICENSE, MEDICAL BOARD
SC
01
52283-020
WI LICENSE
WI
Enumeration date
11/11/2008
Last updated
03/13/2019
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