Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301099079 | MI |
NPI | 1013275866 |
---|---|
Provider Name | Brooke M Frakes |
First Address | Southfield, MI 48034-1671 |
Second Address | Detroit, MI 48235-2624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2012 |
Last Update Date | 21/07/2021 |