=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861510158
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANK MARRE DO, MS FAOCOPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1231 E BELTLINE AVE NE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49525-7024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-464-8615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 334
-----------------------------------------------------
City | ADA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49301-0334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-682-1143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number | 5101015648
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------