Basic Information
Provider Information
NPI: 1730159294
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRANKEL
FirstName: KEVIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26901 BEAUMONT BLVD STE 3D
Address2:  
City: SOUTHFIELD
State: MI
PostalCode: 480333849
CountryCode: US
TelephoneNumber: 9475221862
FaxNumber: 9475220307
Practice Location
Address1: 14001 GREENFIELD RD
Address2:  
City: DETROIT
State: MI
PostalCode: 482272101
CountryCode: US
TelephoneNumber: 3132731200
FaxNumber: 3132738130
Other Information
ProviderEnumerationDate: 01/25/2006
LastUpdateDate: 11/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X5101012750MIY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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