Basic Information
| Provider Information | |||||||||
| NPI: | 1689673311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLLENKOPF | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 S CEDAR ST | ||||||||
| Address2: | STE 116 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489104699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178872511 | ||||||||
| FaxNumber: | 5178824144 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 W GREENLAWN AVE | ||||||||
| Address2: | STE 400 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489102898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174837550 | ||||||||
| FaxNumber: | 5178824144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 5601003067 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.