Provider Demographics
NPI:1851481063
Name:FREDERIKSEN, MICHAEL S (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:FREDERIKSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S OHIO ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3177
Mailing Address - Country:US
Mailing Address - Phone:785-825-0003
Mailing Address - Fax:785-825-0099
Practice Address - Street 1:430 S OHIO ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3177
Practice Address - Country:US
Practice Address - Phone:785-825-0003
Practice Address - Fax:785-825-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00322213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU84963Medicare UPIN
KS114115Medicare ID - Type Unspecified