Basic Information
| Provider Information | |||||||||
| NPI: | 1437260338 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREI | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | RENE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 FRANK LLOYD WRIGHT DR | ||||||||
| Address2: | PO BOX 0446 LOBBY J | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481059484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343270872 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4936 W CLARK RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481970861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344343000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 50115091205 | UT | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 4301072613 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 4301072613 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.