Healthcare Provider Details

I. General information

NPI: 1861510158
Provider Name (Legal Business Name): FRANK MARRE DO, MS FAOCOPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-7024
US

IV. Provider business mailing address

PO BOX 334
ADA MI
49301-0334
US

V. Phone/Fax

Practice location:
  • Phone: 616-464-8615
  • Fax:
Mailing address:
  • Phone: 616-682-1143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number5101015648
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: