Provider Demographics
NPI:1306901103
Name:GREAVES, FREDERICK G (EDD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:G
Last Name:GREAVES
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 GOLFVIEW
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080
Mailing Address - Country:US
Mailing Address - Phone:269-664-5846
Mailing Address - Fax:
Practice Address - Street 1:4031 W MAIN
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006
Practice Address - Country:US
Practice Address - Phone:269-567-4202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002583103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68OC91218OtherBLUE CROSS
MIOC94520Medicare ID - Type Unspecified