Provider Demographics
NPI:1629698535
Name:SEBASTIAN, FRENY (MD)
Entity type:Individual
Prefix:
First Name:FRENY
Middle Name:
Last Name:SEBASTIAN
Suffix:
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 1:17000 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1263
Mailing Address - Country:US
Mailing Address - Phone:586-563-5555
Mailing Address - Fax:586-563-1778
Practice Address - Street 1:17000 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1263
Practice Address - Country:US
Practice Address - Phone:586-563-5555
Practice Address - Fax:586-563-1778
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301508772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine