Provider Demographics
NPI:1821190232
Name:FRAZIN, LAWRENCE JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JEFFREY
Last Name:FRAZIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3201 S 16TH ST
Mailing Address - Street 2:SUITE 2025
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4534
Mailing Address - Country:US
Mailing Address - Phone:414-645-8977
Mailing Address - Fax:414-645-8988
Practice Address - Street 1:3201 S 16TH ST
Practice Address - Street 2:SUITE 2025
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4534
Practice Address - Country:US
Practice Address - Phone:414-645-8977
Practice Address - Fax:414-645-8988
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI18499207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30185800Medicaid
WIB84852Medicare UPIN