MEDICARE: MARVIN L FRANKLIN INDEPENDENT PROVIDER

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1972106805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVIN L FRANKLIN INDEPENDENT PROVIDER

Provider Business Mailing Address
First Line	:	1002 LAKE ST
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-2743
Country	:	US
Telephone Number	:	234-233-4496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 LAKE ST
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-2743
Country	:	US
Telephone Number	:	234-233-4496
Fax Number	:

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

Provider Enumeration Date	:	11/22/2020
Last Update Date	:	11/22/2020

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