Provider Demographics
NPI:1386681948
Name:FREEDMAN, MITCHELL KIRK (DO)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:KIRK
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:800-321-9999
Mailing Address - Fax:267-479-1321
Practice Address - Street 1:3300 TILLMAN DR FL 2
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2071
Practice Address - Country:US
Practice Address - Phone:267-339-3558
Practice Address - Fax:267-339-3763
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3071992081P2900X
NJ25MB0502018002081P2900X
PAOS005070L2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0053469OtherAETNA
PA0032628000OtherIBC
127775OtherCIGNA
PA250009015Medicare PIN
C31014Medicare UPIN
PA127775GC6Medicare ID - Type Unspecified