Provider Demographics
NPI:1215192745
Name:FARBOD, M.D., D.M.D, FRANK (MD,DMD, FACS, FRCS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:FARBOD, M.D., D.M.D
Suffix:
Gender:M
Credentials:MD,DMD, FACS, FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 LINCOLN AVE #4
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-0171
Mailing Address - Country:US
Mailing Address - Phone:906-225-5959
Mailing Address - Fax:
Practice Address - Street 1:1029 LINCOLN AVE STE 4
Practice Address - Street 2:SUITE 4
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2680
Practice Address - Country:US
Practice Address - Phone:906-225-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106347208600000X, 2082S0099X, 204E00000X
MI29010195121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery