Basic Information
| Provider Information | |||||||||
| NPI: | 1558363853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHREIBER | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4442 GENESYS PKWY | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484398072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669742673 | ||||||||
| FaxNumber: | 8669392673 | ||||||||
| Practice Location | |||||||||
| Address1: | 4442 GENESYS PKWY | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484398072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669742673 | ||||||||
| FaxNumber: | 8669392673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 01/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | 5101006977 | MI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 174400000X | 5101006977 | MI | N | Other Service Providers | Specialist | 207X00000X | 5101006977 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 105256 | 01 | MI | CARE CHOICE | OTHER | 2052500175 | 01 | MI | BLUE CARE NETWORK | OTHER | 2894752 | 05 | MI | MEDICAID | 38-2710423 | 01 | MI | TAX ID EFF 1.19.15 | OTHER | 382368031 | 01 | MI | PPOM | OTHER | 5250017 | 01 | MI | BLUE CROSS OF MICHIGAN | OTHER | 120628 | 01 | MI | SELECTCARE | OTHER | E25876 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | P50685 | 01 | MI | BLUECARE NETWORK | OTHER | 200001927 | 01 | MI | RAILROAD MEDICARE | OTHER | 2169770 | 01 | MI | CHAMPUS/TRICARE | OTHER | 2000175 | 01 | MI | HEALTHPLUS OF MICHIGAN | OTHER | 4073451 | 01 | MI | AETNA | OTHER | C2512 | 01 | MI | MCARE | OTHER |