Healthcare Provider Details

I. General information

NPI: 1285660605
Provider Name (Legal Business Name): MARC A FRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S CORAL ST
KALKASKA MI
49646-2500
US

IV. Provider business mailing address

419 S CORAL ST
KALKASKA MI
49646-2500
US

V. Phone/Fax

Practice location:
  • Phone: 231-258-7777
  • Fax: 231-258-7786
Mailing address:
  • Phone: 231-258-7777
  • Fax: 231-258-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301045429
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: