Provider Demographics
NPI:1063847416
Name:WEDEKING, FRED LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:LEE
Last Name:WEDEKING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2102
Mailing Address - Country:US
Mailing Address - Phone:269-381-3960
Mailing Address - Fax:269-381-3960
Practice Address - Street 1:1034 CROWN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2102
Practice Address - Country:US
Practice Address - Phone:269-381-3960
Practice Address - Fax:269-381-3960
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301026782207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine