Provider Demographics
NPI:1033104807
Name:FREELAND, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:FREELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1616 GRAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-3676
Mailing Address - Country:US
Mailing Address - Phone:847-623-0032
Mailing Address - Fax:847-623-0505
Practice Address - Street 1:1616 GRAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-3600
Practice Address - Country:US
Practice Address - Phone:847-623-0032
Practice Address - Fax:847-623-0505
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36038789207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036038789Medicaid
IL304690001Medicare PIN
IL036038789Medicaid