Organization
SHELLEY FREIMARK, MD, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY LYNN FREIMARK MD (PRESIDENT)
(616) 296-1143
Entity
Organization
Contact information
Practice address
11257 LAKESHORE DR, GRAND HAVEN, MI 49417-8825
(616) 566-3379
Mailing address
11257 LAKESHORE DR, GRAND HAVEN, MI 49417-8825
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301066173
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104813584
—
MI
01
—
2507011161
BCBSM MI
MI
01
—
SF066173
STATE LICENSE#
MI
Enumeration date
05/23/2006
Last updated
04/15/2020
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