Provider Demographics
NPI:1114062262
Name:FREEDMAN, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24725 W 12 MILE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8337
Mailing Address - Country:US
Mailing Address - Phone:248-351-0011
Mailing Address - Fax:
Practice Address - Street 1:24725 W 12 MILE RD STE 310
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8337
Practice Address - Country:US
Practice Address - Phone:248-351-0011
Practice Address - Fax:248-351-0017
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010287382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1373563Medicaid
MI2606303270OtherBCBSM
MI2606303270OtherBCBSM
MIB42937Medicare UPIN