Provider Demographics
NPI:1386685139
Name:FREEMAN, LASHAWN (DPM)
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
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:PO BOX 19468
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-0468
Mailing Address - Country:US
Mailing Address - Phone:773-363-5523
Mailing Address - Fax:773-363-5602
Practice Address - Street 1:650 GRANT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1533
Practice Address - Country:US
Practice Address - Phone:219-882-2000
Practice Address - Fax:219-881-2836
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005098213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILN375966OtherHARMONY HEALTH
IL016005098Medicaid
IN200901880AMedicaid
ILP00243631OtherRAILROAD MEDICARE
IL0001633214OtherBLUE CROSS BLUE SHIELD
IL016005098Medicaid
ILK05848Medicare PIN
ILU93403Medicare UPIN