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1225547383 NPI number — FRANKENMUTH MEDICAL ASSOCIATES PLLC

NPI Number: 1225547383
Health Care Provider/Practitioner: FRANKENMUTH MEDICAL ASSOCIATES PLLC

Information about “1225547383” NPI (FRANKENMUTH MEDICAL ASSOCIATES PLLC) exists in 1225547383 in HTML format HTML  |  1225547383 in plain Text format TXT  |  1225547383 in PDF (Portable Document Format) PDF  |  1225547383 in an XML format XML  formats.

NPI Number : 1225547383 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225547383",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FRANKENMUTH MEDICAL ASSOCIATES PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 22559",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BELFAST",
    "MailingAddressStateName": "ME",
    "MailingAddressPostalCode": "04915-4474",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "989-502-1122",
    "MailingAddressFaxNumber": "844-674-2260",
    "FirstLinePracticeLocationAddress": "154 S MAIN ST STE 6",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FRANKENMUTH",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48734-1692",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "989-502-1122",
    "PracticeLocationAddressFaxNumber": "989-502-1212",
    "EnumerationDate": "09/21/2017",
    "LastUpdateDate": "10/07/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SURROCK",
    "AuthorizedOfficialFirstName": "LAUREN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PA-C",
    "AuthorizedOfficialTelephoneNumber": "989-502-1122",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "5601006225",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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