Provider Demographics
NPI:1275164808
Name:FRASIK, JOHN BERNARD
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BERNARD
Last Name:FRASIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21699 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2103
Mailing Address - Country:US
Mailing Address - Phone:734-837-6418
Mailing Address - Fax:
Practice Address - Street 1:21699 BEDFORD DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2103
Practice Address - Country:US
Practice Address - Phone:734-837-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801046467104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker