Provider Demographics
NPI:1699798215
Name:FERRES, FRANKLIN S (PA-C)
Entity type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:S
Last Name:FERRES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20952 E 12 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3203
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-7960
Practice Address - Street 1:11051 HALL RD STE 200
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5742
Practice Address - Country:US
Practice Address - Phone:586-254-5759
Practice Address - Fax:586-254-5793
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1699798215Medicaid
MIN87370004Medicare ID - Type Unspecified
MIQ54380Medicare UPIN
MICB9133OtherRAILROAD MEDICARE