Healthcare Provider Details

I. General information

NPI: 1891322889
Provider Name (Legal Business Name): LAITH FREIJ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W BARAGA AVE STE 31
MARQUETTE MI
49855-4550
US

IV. Provider business mailing address

850 W BARAGA AVE STE 31
MARQUETTE MI
49855-4550
US

V. Phone/Fax

Practice location:
  • Phone: 906-449-3610
  • Fax: 833-916-2227
Mailing address:
  • Phone: 906-449-3610
  • Fax: 833-916-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301517770
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: