Provider Demographics
NPI:1225547383
Name:FRANKENMUTH MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:FRANKENMUTH MEDICAL ASSOCIATES PLLC
Other - Org Name:SAGINAW MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SURROCK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:989-502-1122
Mailing Address - Street 1:PO BOX 22559
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4474
Mailing Address - Country:US
Mailing Address - Phone:989-502-1122
Mailing Address - Fax:844-674-2260
Practice Address - Street 1:154 S MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1692
Practice Address - Country:US
Practice Address - Phone:989-502-1122
Practice Address - Fax:989-502-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363L00000X
MI5601006225363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty