Provider Demographics
NPI:1013009901
Name:NEUMANN, FREDRIC I I (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:I
Last Name:NEUMANN
Suffix:I
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:39880 VAN DYKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313
Mailing Address - Country:US
Mailing Address - Phone:586-939-9060
Mailing Address - Fax:586-939-6639
Practice Address - Street 1:39880 VAN DYKE
Practice Address - Street 2:SUITE 102
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313
Practice Address - Country:US
Practice Address - Phone:586-939-9060
Practice Address - Fax:586-939-6639
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFN009587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP9044OtherBLUE CARE NETWORK
MI08-0-E0-1042OtherBLUE CROSS AND BLUE SHIEL
MI43253579OtherAETNA
MI3229747Medicaid
MI080082386OtherRAILROAD MEDICARE
MI383277109OtherTAX IDENIFICATION
MI23D0371615OtherCLIA
MIP9044OtherBLUE CARE NETWORK
MI23D0371615OtherCLIA