Provider Demographics
NPI:1407251366
Name:FRAZIER, LEONARDO
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:FRAZIER
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 1:11350 KINLOCH
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2161
Mailing Address - Country:US
Mailing Address - Phone:313-544-0287
Mailing Address - Fax:
Practice Address - Street 1:11350 KINLOCH
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-2161
Practice Address - Country:US
Practice Address - Phone:313-544-0287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide