Healthcare Provider Details

I. General information

NPI: 1942725296
Provider Name (Legal Business Name): JULIA SOPHIE FRUH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA SOPHIE FRUEH M.D.

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date: 08/14/2018
Reactivation Date: 08/27/2018

III. Provider practice location address

1000 OAKLAND DRIVE
KALAMAZOO MI
49008
US

IV. Provider business mailing address

1000 OAKLAND DRIVE
KALAMAZOO MI
49008
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-6400
  • Fax: 269-337-6434
Mailing address:
  • Phone: 269-337-6400
  • Fax: 269-337-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351043239
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: