Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 4301036639 | MI |
NPI | 1063563187 |
---|---|
Provider Name | Dr. Lee Stephen Fruman |
First Address | Franklin, MI 48025-1644 |
Second Address | Franklin, MI 48025-1644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0806311882 | (02) | MI |