Provider Demographics
NPI:1578984530
Name:FRENTZ, LISA MICHELLE (BS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:FRENTZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 JEFFREY AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2583
Mailing Address - Country:US
Mailing Address - Phone:248-515-9035
Mailing Address - Fax:
Practice Address - Street 1:207 JEFFREY AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-2583
Practice Address - Country:US
Practice Address - Phone:248-515-9035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management