Healthcare Provider Details

I. General information

NPI: 1427147982
Provider Name (Legal Business Name): ALFRED FRANZBLAU M.D., M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR MED INN BLDG/C380
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

2850 S INDUSTRIAL HWY SUITE 600
ANN ARBOR MI
48104-6796
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-0758
  • Fax:
Mailing address:
  • Phone: 734-975-3039
  • Fax: 734-975-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301055331
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: