Provider Demographics
NPI:1205809175
Name:FREDMAN, CAREY S (MD)
Entity type:Individual
Prefix:DR
First Name:CAREY
Middle Name:S
Last Name:FREDMAN
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 952273
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2273
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-432-0223
Practice Address - Street 1:222 S WOODS MILL RD STE 400N
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3610
Practice Address - Country:US
Practice Address - Phone:314-317-9863
Practice Address - Fax:314-317-9806
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4D51207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO060061518OtherRAILROAD MEDICARE IND #
MOCH4229OtherRR MEDICARE GROUP#
MO001013355Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
MO000013355Medicare ID - Type UnspecifiedGROUP PROVIDER#
MOCH4229OtherRR MEDICARE GROUP#
MO505207209Medicaid
MO202878336Medicaid