Provider Demographics
NPI:1255520573
Name:DANIEL P FREEMAN MD PC
Entity type:Organization
Organization Name:DANIEL P FREEMAN MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-788-8408
Mailing Address - Street 1:900 E MICHIGAN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2490
Mailing Address - Country:US
Mailing Address - Phone:517-788-8408
Mailing Address - Fax:
Practice Address - Street 1:900 E MICHIGAN AVE STE 102
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2490
Practice Address - Country:US
Practice Address - Phone:517-788-8408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010558142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3238577Medicaid
MI3238577Medicaid
MIOP01670Medicare PIN