Provider Demographics
NPI:1629698535
Name:SEBASTIAN, FRENY (MD)
Entity Type:Individual
Prefix:
First Name:FRENY
Middle Name:
Last Name:SEBASTIAN
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 1:22101 MOROSS RD
Mailing Address - Street 2:PB2, SUITE 50
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-343-7774
Mailing Address - Fax:313-343-8747
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:SUITE 50
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-343-7774
Practice Address - Fax:313-343-8747
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301508772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine