Healthcare Provider Details

I. General information

NPI: 1053035253
Provider Name (Legal Business Name): FRANK LEE AVINA RRT,RPSGT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5622 PARKWOOD BLVD
SYLVANIA OH
43560-1963
US

IV. Provider business mailing address

2500 GREEN RD STE 200
ANN ARBOR MI
48105-1573
US

V. Phone/Fax

Practice location:
  • Phone: 419-460-2029
  • Fax:
Mailing address:
  • Phone: 734-222-4277
  • Fax: 734-222-4383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number4727
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: