Provider Demographics
NPI:1346645496
Name:FREILICH, RONALD ETHAN (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ETHAN
Last Name:FREILICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25107 CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:JONESBURG
Mailing Address - State:MO
Mailing Address - Zip Code:63351-2454
Mailing Address - Country:US
Mailing Address - Phone:314-575-5112
Mailing Address - Fax:
Practice Address - Street 1:25107 CHEROKEE LN
Practice Address - Street 2:
Practice Address - City:JONESBURG
Practice Address - State:MO
Practice Address - Zip Code:63351-2454
Practice Address - Country:US
Practice Address - Phone:314-575-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.004215213ES0103X, 213E00000X
MO2015014633213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist