Provider Demographics
NPI:1578637187
Name:BIRKMEIER-FREDAL, TERESA S (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:S
Last Name:BIRKMEIER-FREDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 BARCLAY CIR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5815
Mailing Address - Country:US
Mailing Address - Phone:248-289-6349
Mailing Address - Fax:248-289-6923
Practice Address - Street 1:245 BARCLAY CIR
Practice Address - Street 2:SUITE 600
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5815
Practice Address - Country:US
Practice Address - Phone:248-289-6349
Practice Address - Fax:248-289-6923
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI444545210Medicaid
080H262390OtherBLUE CROSS-BLUE CROSS
TB074918OtherCHAMPUS-CHAMPUS
TB074918OtherCOMMERCIAL-COMMERCIAL NUMBER
080H262390OtherBLUE CROSS-BLUE CROSS
TB074918OtherCHAMPUS-CHAMPUS