=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245179761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M&D WELLNESS ADMINISTRATION SERVICES L3C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2026
-----------------------------------------------------
Last Update Date | 03/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14525 MACK AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48215-2520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-480-5880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14525 MACK AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48215-2520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-480-5880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ ADMINISTRATOR
-----------------------------------------------------
Name | MS. STEPHANIE ANN FRAZIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-480-5880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------