Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301083979 | MI |
N | 207VG0400X | Gynecologist | 4301083979 | MI |
N | 207VX0000X | Obstetrician | 4301083979 | MI |
NPI | 1215148689 |
---|---|
Provider Name | Regina Frost |
First Address | Saint Clair Shores, MI 48080-6445 |
Second Address | Saint Clair Shores, MI 48080-2388 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 18/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16-0502285-2 | BCBS INDIVIDUAL PIN (01) | MI |
700E012740 | BCBS GROUP NUMBER (01) | MI |