| Placed On Purpose | |
|
3675 N River Rd Fort Gratiot MI 48059-4147 | |
| (810) 292-2391 | |
| Not Available |
| Full Name | Placed On Purpose |
|---|---|
| Speciality | Social Worker |
| Location | 3675 N River Rd, Fort Gratiot, Michigan |
| Authorized Official Name and Position | Devon Frontczak (OWNER) |
| Authorized Official Contact | 8102922391 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Placed On Purpose 1640 Colorado St Marysville MI 48040-1644 Ph: () - | Placed On Purpose 3675 N River Rd Fort Gratiot MI 48059-4147 Ph: (810) 292-2391 |
| NPI Number | 1427820471 |
|---|---|
| Provider Enumeration Date | 10/24/2023 |
| Last Update Date | 02/12/2024 |
| Certification Date | 02/12/2024 |
| Medicare PECOS PAC ID | 0941647010 |
|---|---|
| Medicare Enrollment ID | O20240325002862 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427820471 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Devon W Frontczak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184043309 PECOS PAC ID: 2365804036 Enrollment ID: I20230811001004 |
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