Provider Demographics
NPI:1821079666
Name:WURSTER, FRED R (DO)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:R
Last Name:WURSTER
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:PO BOX 1074
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-5074
Mailing Address - Country:US
Mailing Address - Phone:810-660-7902
Mailing Address - Fax:810-660-7904
Practice Address - Street 1:1257 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1346
Practice Address - Country:US
Practice Address - Phone:810-660-7902
Practice Address - Fax:810-660-7904
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4120736OtherAETNA
MA0801173750OtherMETRAHEALTH
MI080D400470OtherBCBSM/BCN
MI201554OtherMCLAREN HEALTH PLAN
MI080D400470OtherBCBSM
MI080D410020OtherBLUE CHOICE POS
MA080D410020OtherBLUE CARE NETWORK
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI0854407884OtherBLUE CROSS BLUE SHIELD
MI201554OtherHEALTH ADVANTAGE NETWORK
MIE25880OtherHEALTH ALLIANCE PLAN
MIE25880OtherHEALTH NET FEDERAL
MI080D410020OtherCOMMUNITY BLUE
MA4651047Medicaid
MIC2596OtherMCARE
MI080D410020OtherCOMMUNITY BLUE
MA080D410020OtherBLUE CARE NETWORK
MIC2596OtherMCARE
MIE25880OtherHEALTH NET FEDERAL