Provider Demographics
NPI:1437357274
Name:FUNKE, FREDERICK W JR (MD)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:W
Last Name:FUNKE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3601 LADSON RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4304
Mailing Address - Country:US
Mailing Address - Phone:843-285-2500
Mailing Address - Fax:843-285-2505
Practice Address - Street 1:3601 LADSON RD
Practice Address - Street 2:STE 100
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4304
Practice Address - Country:US
Practice Address - Phone:843-285-2500
Practice Address - Fax:843-285-2505
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2017-04-25
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Provider Licenses
StateLicense IDTaxonomies
SC29994207RC0000X, 207RI0011X, 207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy