Provider Demographics
NPI:1073189890
Name:FREEDOM HEALTH PROVIDERS LLC
Entity Type:Organization
Organization Name:FREEDOM HEALTH PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-643-2808
Mailing Address - Street 1:26 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-3605
Mailing Address - Country:US
Mailing Address - Phone:954-643-2808
Mailing Address - Fax:
Practice Address - Street 1:26 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-3605
Practice Address - Country:US
Practice Address - Phone:954-643-2808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty