Provider Demographics
NPI:1437345931
Name:FLETCHER, FREDERIC ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:ALAN
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:38238 CONNAUGHT DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-9090
Mailing Address - Country:US
Mailing Address - Phone:248-427-1224
Mailing Address - Fax:248-427-9236
Practice Address - Street 1:38238 CONNAUGHT DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-9090
Practice Address - Country:US
Practice Address - Phone:248-427-1224
Practice Address - Fax:248-427-9236
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2008-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101004994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE25852Medicare UPIN