Healthcare Provider Details

I. General information

NPI: 1780893867
Provider Name (Legal Business Name): ANGELA MARIE FROST FERRELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49200 WIXOM TECH DR
WIXOM MI
48393-3560
US

IV. Provider business mailing address

1979 HURON PKWY
ANN ARBOR MI
48104-4141
US

V. Phone/Fax

Practice location:
  • Phone: 734-344-4567
  • Fax: 734-669-1104
Mailing address:
  • Phone: 734-344-4567
  • Fax: 734-669-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301087997
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: