Provider Demographics
NPI:1184850158
Name:FRAZIER, PAMELA TAVERNELLI (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:TAVERNELLI
Last Name:FRAZIER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:676 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2883
Mailing Address - Country:US
Mailing Address - Phone:602-617-6854
Mailing Address - Fax:312-335-9311
Practice Address - Street 1:4300 N MILLER RD
Practice Address - Street 2:SUITE 142
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3619
Practice Address - Country:US
Practice Address - Phone:602-617-6854
Practice Address - Fax:312-335-9311
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
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Provider Licenses
StateLicense IDTaxonomies
IL036.1228312084P0800X
AZ256712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry