Individual
FRANKLIN FIRESTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3777 NORTH FRONTAGE ROAD, MICHIGAN CITY, IN 46360-7694
(219) 879-6021
(219) 879-6365
Mailing address
PO BOX 1690, LA PORTE, IN 46352-1690
(219) 326-2312
(219) 326-2584
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01035507A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000704703
ANTHEM
IN
05
—
100085090
—
IN
01
—
M400038801
MEDICARE PTAN
IN
Enumeration date
01/23/2006
Last updated
10/25/2011
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