Provider Demographics
NPI:1558341859
Name:FRANKEL, JEROME (DO)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:FRANKEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-585-8216
Mailing Address - Fax:248-858-8266
Practice Address - Street 1:14001 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48277-0001
Practice Address - Country:US
Practice Address - Phone:313-273-1200
Practice Address - Fax:313-273-8130
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006153207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1691432Medicaid
E31601Medicare UPIN