Healthcare Provider Details

I. General information

NPI: 1760663512
Provider Name (Legal Business Name): TERRENCE R FRANK DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

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: 517-487-3664
  • Fax:
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: TERRENCE R FRANK
Title or Position: PRESIDENT
Credential: DO
Phone: 517-487-3655