Healthcare Provider Details

I. General information

NPI: 1316381387
Provider Name (Legal Business Name): ADAM GIRARD FRIMODIG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56720 CALUMET AVE
CALUMET MI
49913-1967
US

IV. Provider business mailing address

301 EXPLORER ST
GWINN MI
49841-2813
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1177
  • Fax: 906-483-1188
Mailing address:
  • Phone: 906-346-4924
  • Fax: 906-346-6474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101020797
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: