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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

NPI # 1700625761
LBN Legal business name DR FRED PLLC
Authorized official FREDRIC REYELTS - (PRESIDENT / CMO)
Entity Organization
Organization subpart 1 No
Enumeration date 05/20/2024
Last updated 11/19/2025 - About 7 months ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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