Provider Demographics
NPI:1730236639
Name:VINCENT, FREDERICK MICHAEL SR (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:MICHAEL
Last Name:VINCENT
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2740
Mailing Address - Country:US
Mailing Address - Phone:517-337-3080
Mailing Address - Fax:517-337-3082
Practice Address - Street 1:250 E SAGINAW ST
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2740
Practice Address - Country:US
Practice Address - Phone:517-337-3080
Practice Address - Fax:517-337-3082
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010351332084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1687260Medicaid
MIB49544Medicare UPIN