Provider Demographics
NPI:1821708264
Name:FRYE, WHITMAN WILLIAM JR
Entity Type:Individual
Prefix:MR
First Name:WHITMAN
Middle Name:WILLIAM
Last Name:FRYE
Suffix:JR
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 1:28386 RALEIGH CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2308
Mailing Address - Country:US
Mailing Address - Phone:810-892-3929
Mailing Address - Fax:
Practice Address - Street 1:28386 RALEIGH CRESCENT DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2308
Practice Address - Country:US
Practice Address - Phone:810-892-3929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF600873887650172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver