Provider Demographics
NPI:1043385784
Name:JUNN, FREDRICK S (MD)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:S
Last Name:JUNN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29275 NORTHWESTERN HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:248-784-3667
Mailing Address - Fax:248-869-3982
Practice Address - Street 1:18181 OAKWOOD BLVD STE 403
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3960
Practice Address - Country:US
Practice Address - Phone:313-438-5560
Practice Address - Fax:313-438-5575
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2024-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301067029207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FJ067029OtherCOMMERCIAL-COMMERCIAL NUMBER
FJ067029OtherCOMMERCIAL-COMMERCIAL NUMBER