Healthcare Provider Details

I. General information

NPI: 1881174548
Provider Name (Legal Business Name): MICHAEL CAMERON FRALICK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

7001 SEAVIEW AVE NW STE 160-656
SEATTLE WA
98117-6006
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2111
  • Fax: 505-925-7290
Mailing address:
  • Phone: 360-820-2430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2020-0048
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: