Provider Demographics
NPI:1639451487
Name:SPAIN, FRANK L
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:L
Last Name:SPAIN
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 1:10144 W JONEN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-5227
Mailing Address - Country:US
Mailing Address - Phone:414-793-9408
Mailing Address - Fax:414-755-2919
Practice Address - Street 1:10144 W JONEN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-5227
Practice Address - Country:US
Practice Address - Phone:414-793-9408
Practice Address - Fax:414-755-2919
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver