Provider Demographics
NPI:1417312224
Name:SAMUEL M FREEDMAN,MD
Entity Type:Organization
Organization Name:SAMUEL M FREEDMAN,MD
Other - Org Name:SAMUEL M FREEDMAN,MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-447-1198
Mailing Address - Street 1:601 N FLAMINGO RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1015
Mailing Address - Country:US
Mailing Address - Phone:954-447-1198
Mailing Address - Fax:954-447-9893
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:SUITE 207
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-447-1198
Practice Address - Fax:954-447-9893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010225700Medicaid