Provider Demographics
NPI:1922539717
Name:DESCOTEAUX-FRIDAY, GARRETT (DO)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:DESCOTEAUX-FRIDAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:GARRETT
Other - Middle Name:JAMES
Other - Last Name:FRIDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3955 PATIENT CARE DR STE A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4271
Mailing Address - Country:US
Mailing Address - Phone:517-374-7600
Mailing Address - Fax:855-495-5457
Practice Address - Street 1:3955 PATIENT CARE DR STE A
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4271
Practice Address - Country:US
Practice Address - Phone:517-374-7600
Practice Address - Fax:855-495-5457
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA336228208M00000X
390200000X
MI5101023652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program