Provider Demographics
NPI:1659341691
Name:LOPATIN, FREDERICK LOUIS (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LOUIS
Last Name:LOPATIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4729 MAURA LN
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3626
Mailing Address - Country:US
Mailing Address - Phone:248-865-9678
Mailing Address - Fax:
Practice Address - Street 1:22731 NEWMAN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-582-8853
Practice Address - Fax:313-582-6417
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011463174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG48911Medicare UPIN
MIOM59180Medicare PIN