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1972951200
FREDY MASONGSONG
SOUTHGATE, MI
NPI
1972951200
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner Family
(Licence: MI 4704244001)
Enumeration Date
2016-05-26
Last Update Date
2020-11-17
Business Address
FREDY MASONGSONG
13667 EUREKA RD
SOUTHGATE, MI 48195-1332
Phone number: 734-530-6777
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Mailing Address
FREDY MASONGSONG
PO BOX 746723
ATLANTA, GA 30374-6723
Phone number: 312-733-9730
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