MEDICARE: FRANKLIN FIRESTONE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01035507A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M400038801	OTHER	IN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000704703	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1164492245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANKLIN FIRESTONE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1690
Second Line	:
City	:	LA PORTE
State	:	IN
Zip	:	46352-1690
Country	:	US
Telephone Number	:	219-326-2312
Fax Number	:	219-326-2584

Provider Business Practice Location Address
First Line	:	3777 NORTH FRONTAGE ROAD
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-7694
Country	:	US
Telephone Number	:	219-879-6021
Fax Number	:	219-879-6365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	10/25/2011

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Directions to “ FRANKLIN FIRESTONE M.D.” Practice Location

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