Provider Demographics
NPI:1942209671
Name:FROL, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:FROL
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 1:8555 N SILVERY LN
Mailing Address - Street 2:SUITE C302
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1379
Mailing Address - Country:US
Mailing Address - Phone:313-561-0550
Mailing Address - Fax:313-561-3646
Practice Address - Street 1:8555 N SILVERY LN
Practice Address - Street 2:SUITE C302
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1379
Practice Address - Country:US
Practice Address - Phone:313-561-0550
Practice Address - Fax:313-561-3646
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBF046396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI134150OtherCARE CHOICES
MI5802218OtherAETNA
MI4492601Medicaid
MIB47346OtherHAP
MI4492601Medicaid