Provider Demographics
NPI:1073609400
Name:FRANKOVICH, TERESA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:FRANKOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 9TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6249
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:2200 TYDD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-269-7051
Practice Address - Fax:707-269-7054
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073637208000000X
CAG66089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4354140Medicaid
MI4301073637OtherSTATE LICENSE
MI700Z745720OtherBCBS
MI231845Medicare ID - Type UnspecifiedFQHC
MI4354140Medicaid