Healthcare Provider Details

I. General information

NPI: 1629089230
Provider Name (Legal Business Name): FRANK W PAVLOVCIC III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/26/2024
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NORTH MAIN STREET SUITE 150
CHELSEA MI
48118
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE SUITE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-593-5251
  • Fax: 734-593-5255
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0102201410
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101019070
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: