Provider Demographics
NPI:1154431955
Name:FRANTOM, JOHN W
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:FRANTOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 MORTHLAND DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6246
Mailing Address - Country:US
Mailing Address - Phone:219-462-3081
Mailing Address - Fax:219-462-4204
Practice Address - Street 1:1454 MORTHLAND DR
Practice Address - Street 2:SUITE 2
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6246
Practice Address - Country:US
Practice Address - Phone:219-462-3081
Practice Address - Fax:219-462-4204
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200175850AMedicaid
IN1218260001Medicare NSC