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NPI Code Detail

MEDICARE: MARILYNN E FREDERIKSEN M.D.

MEDICARE: MARILYNN E FREDERIKSEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VM0101XMaternal & Fetal Medicine Physician36058725IL
2207VM0101XMaternal & Fetal Medicine Physician68138WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11627904OTHERILBLUE CROSS/BLUE SHIELD NO
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811996796
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYNN E FREDERIKSEN M.D.
Provider Business Mailing Address
First Line : 945 N 12TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-1305
Country : US
Telephone Number : 414-219-7956
Fax Number :
Provider Business Practice Location Address
First Line : 945 N 12TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-1305
Country : US
Telephone Number : 414-219-7956
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 09/04/2019

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