Healthcare Provider Details

I. General information

NPI: 1235545708
Provider Name (Legal Business Name): LEO RICHARD FRECHETTE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2014
Last Update Date: 07/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8980 SW 56TH ST
MIAMI FL
33165-6641
US

IV. Provider business mailing address

8980 SW 56TH ST
MIAMI FL
33165-6641
US

V. Phone/Fax

Practice location:
  • Phone: 612-222-7772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number214641-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: