MEDICARE: DANIELLE FRAZER-MARTINCHEK RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1720642101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE FRAZER-MARTINCHEK RDN

Provider Business Mailing Address
First Line	:	6035 RUPRECHT RD
Second Line	:
City	:	TWIN LAKE
State	:	MI
Zip	:	49457-9602
Country	:	US
Telephone Number	:	248-925-6030
Fax Number	:

Provider Business Practice Location Address
First Line	:	6035 RUPRECHT RD
Second Line	:
City	:	TWIN LAKE
State	:	MI
Zip	:	49457-9602
Country	:	US
Telephone Number	:	248-925-6030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2019
Last Update Date	:	05/01/2019

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Directions to “ DANIELLE FRAZER-MARTINCHEK RDN” Practice Location

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