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Contact Information

DR FRED PLLC
2100 RAYBROOK ST SE
STE 100B
GRAND RAPIDS, MI49546
 Phone: 616-320-0096
 Fax: 616-320-0097
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Adult Health

363LA2200X 50 Nurse Practitioner
 

Medical

363AM0700X 97 Physician Assistant
 

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for DR FRED PLLC · (Female)

NPI Number 1700625761
Status Active
Credentials
Entity Individual
Enumeration date 05/20/2024
Last updated 11/19/2025 - About 7 months ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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