Healthcare Provider Details

I. General information

NPI: 1942820840
Provider Name (Legal Business Name): JOSEPH FRAZEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3922 CEDAR RUN RD
TRAVERSE CITY MI
49684-9687
US

IV. Provider business mailing address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2386
US

V. Phone/Fax

Practice location:
  • Phone: 231-392-0430
  • Fax: 231-935-3438
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number5101027912
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: