Provider Demographics
NPI:1679592828
Name:ADDO, FRANK A (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:A
Last Name:ADDO
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 1:707 CEDAR ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2349 LAKE AVE STE 99
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-7837
Practice Address - Country:US
Practice Address - Phone:574-948-5340
Practice Address - Fax:574-948-5494
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36735207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300045013Medicaid
IN000001452700OtherBCBS
IN000001492043OtherBCBS
IN300045013Medicaid
IAI18203Medicare PIN
IAI18182Medicare PIN
I159922Medicare UPIN
IAI18179Medicare PIN
IAI18183Medicare PIN
IAI18187Medicare PIN
IAI18191Medicare PIN
I18202Medicare PIN
IAI18180Medicare PIN
IAI18181Medicare PIN
IAI18204Medicare PIN
IAI18184Medicare PIN
IAI18189Medicare PIN
IAI18178Medicare PIN