Provider Demographics
NPI:1255008207
Name:FRAZIER REED, ROSLYN L (MEDICAL PROSTHESIC)
Entity Type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:L
Last Name:FRAZIER REED
Suffix:
Gender:F
Credentials:MEDICAL PROSTHESIC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:39500 W 10 MILE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2947
Mailing Address - Country:US
Mailing Address - Phone:248-719-4778
Mailing Address - Fax:248-793-9926
Practice Address - Street 1:39500 W 10 MILE RD STE 105
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2947
Practice Address - Country:US
Practice Address - Phone:248-719-4778
Practice Address - Fax:248-793-9926
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI1744P3200X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management