Provider Demographics
NPI:1174559900
Name:FARROW, FREEMAN L (MD)
Entity type:Individual
Prefix:DR
First Name:FREEMAN
Middle Name:L
Last Name:FARROW
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 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:900 I ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5533
Practice Address - Country:US
Practice Address - Phone:219-324-1700
Practice Address - Fax:574-324-1602
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074082A207Q00000X
IN010740082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000878094OtherBCBS LAPORTE
IN000000935610OtherBCBS BMG E BLAIR WARNER
IN201228450Medicaid
INP01356550OtherRR MEDICARE
IN000000878094OtherBCBS LAPORTE
162520035Medicare PIN
IN000000935610OtherBCBS BMG E BLAIR WARNER