Provider Demographics
NPI:1548268626
Name:FROWNFELTER, JOHN GLEN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GLEN
Last Name:FROWNFELTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25925 TELEGRAPH RD
Mailing Address - Street 2:210
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2518
Mailing Address - Country:US
Mailing Address - Phone:248-746-0342
Mailing Address - Fax:248-746-0308
Practice Address - Street 1:16001 W 9 MILE RD
Practice Address - Street 2:DEPT OF INTERNAL MEDICINE
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-3152
Practice Address - Fax:248-849-3230
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MI4301061866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301061866OtherCONTROLLED SUBSTANCE
BF5378559OtherFEDERAL DEA
BF5378559OtherFEDERAL DEA