Provider Demographics
NPI:1558533539
Name:RONALD L FREEMAN, M.D., S.C.
Entity Type:Organization
Organization Name:RONALD L FREEMAN, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-367-7080
Mailing Address - Street 1:755 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3253
Mailing Address - Country:US
Mailing Address - Phone:847-367-7080
Mailing Address - Fax:847-367-7095
Practice Address - Street 1:755 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3253
Practice Address - Country:US
Practice Address - Phone:847-367-7080
Practice Address - Fax:847-367-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD10179Medicare UPIN