Provider Demographics
NPI:1568421329
Name:FREIJ, BISHARA
Entity Type:Individual
Prefix:
First Name:BISHARA
Middle Name:
Last Name:FREIJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 STEPHENSON HWY
Mailing Address - Street 2:BEAUMONT PAYOR CONTRACT SERVICES
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1103
Mailing Address - Country:US
Mailing Address - Phone:248-577-3511
Mailing Address - Fax:248-577-3526
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:STE. 707
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-551-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010563822080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2662613Medicaid
MI350F361320OtherBCBSM
MI2662613Medicaid