Healthcare Provider Details

I. General information

NPI: 1689871576
Provider Name (Legal Business Name): STACY ANN FRYE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7237 FENTON RD
GRAND BLANC MI
48439-8961
US

IV. Provider business mailing address

7237 FENTON RD
GRAND BLANC MI
48439-8961
US

V. Phone/Fax

Practice location:
  • Phone: 810-223-0500
  • Fax: 810-223-0530
Mailing address:
  • Phone: 810-223-0500
  • Fax: 810-223-0530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301090364
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number4301090364
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number4301090364
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: