Healthcare Provider Details

I. General information

NPI: 1649222043
Provider Name (Legal Business Name): ANNA FRAYMOVICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29703 HOOVER RD
WARREN MI
48093-8901
US

IV. Provider business mailing address

4604 BRIARWOOD AVE
ROYAL OAK MI
48073-1735
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-9090
  • Fax: 586-573-2128
Mailing address:
  • Phone: 248-549-0849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number4301056229
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: