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General NPI Number Information
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NPI Number | 1225547383
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Entity Type | Organization
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Legal Business Name | FRANKENMUTH MEDICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 154 S MAIN ST STE 6
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City | FRANKENMUTH
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State | MI
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Zip | 48734-1692
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Country | US
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Telephone | 989-502-1122
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Fax | 989-502-1212
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Provider Business Mailing Address
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Address Line | PO BOX 22559
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City | BELFAST
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State | ME
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Zip | 04915-4474
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Country | US
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Telephone | 989-502-1122
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Fax | 844-674-2260
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Authorized Official
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Title or Position | CEO
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Name | LAUREN SURROCK
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Credential | PA-C
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Telephone | 989-502-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601006225
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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