Provider Demographics
NPI:1396738597
Name:FREI, JULIA I (DO)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:I
Last Name:FREI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1452
Mailing Address - Country:US
Mailing Address - Phone:906-483-1700
Mailing Address - Fax:906-372-3230
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1452
Practice Address - Country:US
Practice Address - Phone:906-483-1700
Practice Address - Fax:906-372-3230
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010107012080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3445961Medicaid
MIP00064002OtherRAILROAD MEDICARE
MIJF010701OtherBCBS OF MICHIGAN
MIJF010701OtherBCBS OF MICHIGAN
G34429Medicare UPIN