Provider Demographics
NPI:1780672543
Name:FREY, MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:FREY
Suffix:
Gender:M
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:PO BOX 07400
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-0391
Mailing Address - Country:US
Mailing Address - Phone:239-437-8000
Mailing Address - Fax:239-437-9991
Practice Address - Street 1:8255 COLLEGE PKWY
Practice Address - Street 2:STE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5119
Practice Address - Country:US
Practice Address - Phone:239-437-8000
Practice Address - Fax:239-437-9991
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89291208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
37503OtherBCBSF
FL056302100Medicaid
4457197OtherAETNA
37503ZMedicare ID - Type Unspecified
4457197OtherAETNA