Provider Demographics
NPI:1912388182
Name:MELISSA FRANDSEN, MD, LLC
Entity Type:Organization
Organization Name:MELISSA FRANDSEN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-217-9752
Mailing Address - Street 1:11063-D S. MEMORIAL DR.
Mailing Address - Street 2:PMB 212
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:847-217-9752
Mailing Address - Fax:918-957-3395
Practice Address - Street 1:1200 W ALBANY DR
Practice Address - Street 2:REHABILITATION UNIT
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8146
Practice Address - Country:US
Practice Address - Phone:918-615-6581
Practice Address - Fax:918-893-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-14
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24616208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK423820Medicare PIN