MEDICARE: MRS. MARJORIE JANE FREI PA-C

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
1	363AM0700X	Medical Physician Assistant	5601003817	MI

General Provider Information

NPI Number	:	1538140777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARJORIE JANE FREI PA-C

Provider Business Mailing Address
First Line	:	3836 STANDISH RD
Second Line	:
City	:	RHODES
State	:	MI
Zip	:	48652-9514
Country	:	US
Telephone Number	:	989-879-3968
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 E STATE ST
Second Line	:
City	:	STERLING
State	:	MI
Zip	:	48659-9548
Country	:	US
Telephone Number	:	989-654-2491
Fax Number	:	989-654-2190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/26/2009

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