Provider Demographics
NPI:1629115464
Name:FRANDSEN, MELISSA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANNE
Last Name:FRANDSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11063-D S. MEMORIAL DR.
Mailing Address - Street 2:PMB 212
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:847-217-9752
Mailing Address - Fax:918-957-3395
Practice Address - Street 1:1200 W ALBANY ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8146
Practice Address - Country:US
Practice Address - Phone:918-684-3376
Practice Address - Fax:918-681-6814
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24616207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200202540AMedicaid
OKOKAAA1522Medicare PIN