Provider Demographics
NPI:1316141310
Name:FROHM, MARCUS LEE (MD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:LEE
Last Name:FROHM
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-8600
Mailing Address - Fax:605-328-8601
Practice Address - Street 1:1310 W 22ND ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1501
Practice Address - Country:US
Practice Address - Phone:605-328-8600
Practice Address - Fax:605-328-8601
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103869207N00000X
MI4301089830207N00000X, 390200000X
SD9025207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00849655OtherRAIL ROAD - MEDICARE
IAENROLLEDMedicaid
WI35360800Medicaid
MNENROLLEDMedicaid
MN070000800Medicare PIN