Provider Demographics
NPI:1912909250
Name:FREDRICKS, MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:FREDRICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3947
Mailing Address - Country:US
Mailing Address - Phone:281-425-3800
Mailing Address - Fax:281-425-3992
Practice Address - Street 1:910 N HIGHWAY 146 FRONTAGE
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-3947
Practice Address - Country:US
Practice Address - Phone:281-837-7571
Practice Address - Fax:281-425-3992
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127646103Medicaid
TX81710KMedicare ID - Type Unspecified