Healthcare Provider Details

I. General information

NPI: 1215192745
Provider Name (Legal Business Name): FRANK FARBOD, M.D., D.M.D MD,DMD, FACS, FRCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 LINCOLN AVE STE 4 SUITE 4
MARQUETTE MI
49855-2680
US

IV. Provider business mailing address

1029 LINCOLN AVE #4
MARQUETTE MI
49855-0171
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-5959
  • Fax:
Mailing address:
  • Phone: 906-225-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301106347
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number4301106347
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901019512
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number4301106347
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: