Provider Demographics
NPI:1841515145
Name:TERESA BIRKMEIER-FREDAL MD PLLC
Entity type:Organization
Organization Name:TERESA BIRKMEIER-FREDAL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BIRKMEIER-FREDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-259-3773
Mailing Address - Street 1:2770 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1557
Mailing Address - Country:US
Mailing Address - Phone:248-259-3773
Mailing Address - Fax:248-439-1981
Practice Address - Street 1:2770 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1557
Practice Address - Country:US
Practice Address - Phone:248-259-3773
Practice Address - Fax:248-439-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty