Provider Demographics
NPI:1598772808
Name:FREED, MITCHELL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:J
Last Name:FREED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2501 N ORANGE AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-898-2924
Mailing Address - Fax:407-894-5387
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-898-2924
Practice Address - Fax:407-894-5387
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0053196208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0481866-00Medicaid
FLD51437Medicare UPIN
FL0481866-00Medicaid