Basic Information
| Provider Information | |||||||||
| NPI: | 1588691091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FROGGATT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 NAPIER AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490852112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699854632 | ||||||||
| FaxNumber: | 2699854535 | ||||||||
| Practice Location | |||||||||
| Address1: | 1234 NAPIER AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490852112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699854632 | ||||||||
| FaxNumber: | 2699854535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 09/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 4301073475 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 208M00000X | 4301073475 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 4401102601 | 01 | MI | BLUE CROSS | OTHER | 1538397120 | 01 | MI | GROUP NPI | OTHER | 110203683 | 01 | MI | RAILROAD MEDICARE | OTHER | 270381199 | 01 | MI | TAX ID | OTHER | 92-30009 | 01 | MI | PHP | OTHER | BF6181731 | 01 | MI | DEA | OTHER | 4382637 | 05 | MI | MEDICAID | 7501303 | 01 | MI | CIGNA | OTHER |