Provider Demographics
NPI:1437889631
Name:FREELLERGY PLLC
Entity Type:Organization
Organization Name:FREELLERGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIREKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-773-0186
Mailing Address - Street 1:520 E VINE ST # 1558
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2300
Mailing Address - Country:US
Mailing Address - Phone:888-773-0186
Mailing Address - Fax:
Practice Address - Street 1:1400 N COIT RD STE 302
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6656
Practice Address - Country:US
Practice Address - Phone:888-773-0186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN0282OtherMEDICAL LICENSE