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General NPI Number Information
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NPI Number | 1154382158
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Entity Type | Individual
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Provider Name | MICHAEL A FRUMKIN MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 30 NEWPORT WAY
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City | SAN RAFAEL
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State | CA
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Zip | 94901-4411
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Country | US
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Telephone | 315-415-6865
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Fax |
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Provider Business Mailing Address
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Address Line | 30 NEWPORT WAY
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City | SAN RAFAEL
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State | CA
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Zip | 94901-4411
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Country | US
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Telephone | 315-415-6865
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 124060
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G89133
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License Number State | CA
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