Healthcare Provider Details

I. General information

NPI: 1891745311
Provider Name (Legal Business Name): PHILLIP FRANTZIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W MONROE ST STE 200
JACKSON MI
49202-2079
US

IV. Provider business mailing address

950 W MONROE ST STE 200
JACKSON MI
49202-2079
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-3434
  • Fax:
Mailing address:
  • Phone: 517-788-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301407420
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: