Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4101016135 | MI |
NPI | 1053409185 |
---|---|
Provider Name | Dr. Jennifer Ann Freij |
First Address | Troy, MI 48084-7027 |
Second Address | Pontiac, MI 48341-5023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I44970 | (02) | MI |