1477117117 NPI number — DR. CASEY EUGENE FREYMILLER MD

Table of content: DR. CASEY EUGENE FREYMILLER MD (NPI 1477117117)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477117117 NPI number — DR. CASEY EUGENE FREYMILLER MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
FREYMILLER

Provider First Name:
CASEY

Provider Middle Name:
EUGENE

Provider Name Prefix Text:
DR.

Provider Name Suffix Text:

Provider Credential Text:
MD

Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477117117

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
07/11/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7974 UW HEALTH CT

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
MIDDLETON

Provider Business Mailing Address State Name:
WI

Provider Business Mailing Address Postal Code:
53562-5531

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:
804-827-4180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 NYGAARD ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
STOUGHTON

Provider Business Practice Location Address State Name:
WI

Provider Business Practice Location Address Postal Code:
53589-5495

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
608-877-2660

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
04/29/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 208000000X , with the licence number: 0101274752 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 208000000X , with the licence number: 82237-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .