Provider Demographics
NPI:1477597961
Name:FRASCONE, STEPHEN THOMAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:THOMAS
Last Name:FRASCONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32743 23 MILE RD
Mailing Address - Street 2:STE 210
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1985
Mailing Address - Country:US
Mailing Address - Phone:586-725-3444
Mailing Address - Fax:586-725-0984
Practice Address - Street 1:32743 23 MILE RD
Practice Address - Street 2:STE 210
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1985
Practice Address - Country:US
Practice Address - Phone:586-725-3444
Practice Address - Fax:586-725-0984
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISF106911213ES0103X
MI5901001691213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3238666Medicaid
MI3238666Medicaid
0E06226003Medicare PIN
MI0420490001Medicare NSC
0E06226003Medicare PIN