Healthcare Provider Details

I. General information

NPI: 1407853120
Provider Name (Legal Business Name): TERRENCE R FRANK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

2815 S PENNSYLVANIA AVE SUITE 103
LANSING MI
48910-3496
US

IV. Provider business mailing address

2815 S PENNSYLVANIA AVE SUITE 103
LANSING MI
48910-3496
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-3655
  • Fax: 517-487-3664
Mailing address:
  • Phone: 517-487-3655
  • Fax: 517-487-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberTF005949
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: