DR. MARK A FREDRICKSON (NPI# 1356426712) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356426712 |
| Entity Type | Individual |
| Full Name | DR. MARK A FREDRICKSON |
| Credential | MD |
| Practice Address |
3299 Clear Vista Ct Ne Suite C Grand Rapids MI 49525 |
| Practice Telephone | 6163611200 |
| Practice Fax Number | 6163612198 |
| Mailing Telephone | 6163611200 |
| Mailing Fax Number | 6163612198 |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2011-04-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MF048876 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBS MICH | 080D148480 | 01 | |
| MI | 2836516 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962519959 | Mark Fredrickson | Physical Medicine & Rehabilitation | 4502 Medical Dr, San Antonio, TX 78229-4402 | 2006-08-24 |
| 1578530242 | Mark A Fredrickson | Physical Medicine & Rehabilitation | 1800 Heritage Blvd, Midland, TX 79707 | 2006-03-02 |
| Street Address |
3299 CLEAR VISTA CT NE SUITE C |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49525 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528030962 | Colette R. Smiley | Dentist | 3299 Clear Vista Ct Ne, Grand Rapids, MI 49525-9477 | 2006-02-01 |
| 1699154153 | Smiley Family Dentistry, PC | Clinic/Center | 3299 Clear Vista Ct Ne, Suite A, Grand Rapids, MI 49525-9326 | 2015-05-29 |
| 1184054587 | Hamilton Pediatric Dentistry PC | Clinic/Center | 3299 Clear Vista Ct Ne, Suite B, Grand Rapids, MI 49525-9326 | 2013-11-21 |
| 1164659900 | Veronica Ramirez Hamilton | Dentist | 3299 Clear Vista Ct Ne, Suite B, Grand Rapids, MI 49525-9326 | 2009-06-19 |
| 1710144183 | Stephanie Mae Benton-langejans | Dentist | 3299 Clear Vista Ct Ne, Grand Rapids, MI 49525-9326 | 2008-05-21 |
| 1063573319 | Randall Norton Clark | Family Medicine | 3299 Clear Vista Ct Ne, Suite C, Grand Rapids, MI 49525-9477 | 2006-12-12 |
| 1972677656 | Riverwood Family Medicine PC | Family Medicine | 3299 Clear Vista Ct Ne, Suite C, Grand Rapids, MI 49525-9477 | 2006-11-17 |
| 1740233972 | Lisa Vanryn | Physician Assistant | 3299 Clear Vista Ct Ne, Grand Rapids, MI 49525-9326 | 2006-05-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053928507 | Therapy With Nicole Pllc | Community/Behavioral Health | 4867 E. Beltline Ave. Ne, Building #1 Lower Level, Grand Rapids, MI 49525 | 2020-09-29 |
| 1184242760 | Christian Healthcare Specialists, Inc. | Obstetrics & Gynecology | 3322 Beltline Court Ne, Suite 1, Grand Rapids, MI 49525 | 2020-07-09 |
| 1174154645 | Amy Vanderslik | Case Manager/Care Coordinator | 3310 Eaglecrest Park Dr. Ne, Suite 100, Grand Rapids, MI 49525 | 2020-02-03 |
| 1477195246 | Epic Discoveries LLC | Counselor | 4867 E. Beltline Ave Ne, Grand Rapids, MI 49525 | 2019-10-14 |
| 1598228959 | Kim Scherencel Lmsw Counseling | Social Worker | 3280 Beltline Ne, Grand Rapids, MI 49525 | 2019-04-11 |
| 1821558958 | Mindful Trajectories | Social Worker | 3280 Beltlne Ct Ne, Grand Rapids, MI 49525 | 2019-03-24 |
| 1104380518 | Julianne Lettinga, Ma Lpc Counseling | Counselor | 3280 East Beltline Ct Ne, Grand Rapids, MI 49525 | 2019-01-30 |
| 1396227229 | Christopher Scot Doucette | Social Worker | 2064 Airway St Ne, Grand Rapids, MI 49525 | 2018-09-06 |
| 1568976017 | Amy K. Deyoung, Dds, Ms, PC Pediatric Dentistry | Dentist | 3297 Eagle Run Dr. Ne, Grand Rapids, MI 49525 | 2017-11-20 |
| 1407389604 | Kelly Jo Crabb | Social Worker | 4829 E Beltline Ave Ne Ste 100, Grand Rapids, MI 49525 | 2017-04-05 |
| Find all providers in zip 49525 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083239974 | Mercy Health Partners | Family Medicine | 826 Parchment Dr Se Ste 210, Grand Rapids, MI 49546-2307 | 2020-06-16 |
| 1740810563 | Spectrum Health Primary Care Partners | Family Medicine | 435 Ionia Ave Sw, Grand Rapids, MI 49503-5161 | 2020-01-21 |
| 1932748050 | Alexander Corcoran Pa-c LLC | Family Medicine | 2340 College Ave Se, Grand Rapids, MI 49507-3108 | 2020-01-06 |
| 1649757071 | St. Lukes Primary Care | Family Medicine | 5300 Patterson Ave Se Ste 1-d, Grand Rapids, MI 49512 | 2018-07-27 |
| 1619463775 | Zlex, Pllc | Family Medicine | 847 Parchment Dr Se Ste 100, Grand Rapids, MI 49546-2303 | 2018-07-02 |
| 1558856518 | Leland Cary Gyr | Family Medicine | 25 Michigan St Ne Ste 5300, Grand Rapids, MI 49503-2515 | 2018-06-22 |
| 1982126355 | Jeffrey Dufresne | Family Medicine | 300 Lafayette Ave. Se, Grand Rapids, MI 49503 | 2017-07-07 |
| 1386165157 | Samantha V Mcpharlin | Family Medicine | 300 Lafayette Ave Se Ste 400, Grand Rapids, MI 49503 | 2017-07-03 |
| 1639699481 | Andrew R Izzo | Family Medicine | 3200 Eagle Park Dr Ne Ste 102, Grand Rapids, MI 49525-7057 | 2017-06-22 |
| 1871908970 | Marc Arenas | Family Medicine | 245 Cherry St Se Ste 200, Grand Rapids, MI 49503 | 2014-06-26 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49525 |
Please comment or provide details below to improve the information on DR. MARK A FREDRICKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.