1497708556 NPI number — DR. LEE S FREEDMAN MD

Table of content: DR. LEE S FREEDMAN MD (NPI 1497708556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497708556 NPI number — DR. LEE S FREEDMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEDMAN
Provider First Name:
LEE
Provider Middle Name:
S
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:
1497708556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 CENTRAL
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-433-4409
Provider Business Mailing Address Fax Number:
847-433-4495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 CENTRAL
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-433-4409
Provider Business Practice Location Address Fax Number:
847-433-4495
Provider Enumeration Date:
05/18/2006

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: 207R00000X , with the licence number:  036082494 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1538112818 . This is a "CORPORATE NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 743061573 . This is a "PACIFICARE PPO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3119081 . This is a "AETNA/ US HEALTHCARE HMO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 743061573 . This is a "MULTIPLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0000014883 . This is a "OFFICEMED SUBMITTER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 010066196 . This is a "RAILROAD MEDICARE - PALMETTO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4094389 . This is a "AETNA / US HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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