Provider Demographics
NPI:1336189513
Name:FREGENE, TOSAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:TOSAN
Middle Name:A
Last Name:FREGENE
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 47369
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-5069
Mailing Address - Country:US
Mailing Address - Phone:248-967-8800
Mailing Address - Fax:248-967-0035
Practice Address - Street 1:20770 GREENFIELD RD
Practice Address - Street 2:STE A
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3018
Practice Address - Country:US
Practice Address - Phone:249-967-8800
Practice Address - Fax:248-967-0035
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITF053107207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3173875Medicaid
MIF87852Medicare UPIN
MIP35140002Medicare PIN