Provider Demographics
NPI:1861492167
Name:WADENSTORER, FRAZER A (MD)
Entity Type:Individual
Prefix:DR
First Name:FRAZER
Middle Name:A
Last Name:WADENSTORER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G3252 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3614
Mailing Address - Country:US
Mailing Address - Phone:810-230-6800
Mailing Address - Fax:810-230-0713
Practice Address - Street 1:G3252 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3614
Practice Address - Country:US
Practice Address - Phone:810-230-6800
Practice Address - Fax:810-230-0713
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043067207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1661406Medicaid
MIOB56253Medicare ID - Type Unspecified
MI1661406Medicaid