Healthcare Provider Details

I. General information

NPI: 1427372192
Provider Name (Legal Business Name): FRED WURSTER DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 N MAIN ST
LAPEER MI
48446-1346
US

IV. Provider business mailing address

PO BOX 1074
LAPEER MI
48446-5074
US

V. Phone/Fax

Practice location:
  • Phone: 810-660-7902
  • Fax: 810-660-7904
Mailing address:
  • Phone: 810-720-5715
  • Fax: 810-732-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101009054
License Number StateMI

VIII. Authorized Official

Name: FRED WURSTER
Title or Position: OWNER
Credential: DO
Phone: 810-660-7902