Provider Demographics
NPI:1609316470
Name:FREEMAN, MICHEAL LIONELL
Entity Type:Individual
Prefix:MR
First Name:MICHEAL
Middle Name:LIONELL
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 ROLLING GREEN RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6262
Mailing Address - Country:US
Mailing Address - Phone:214-527-4535
Mailing Address - Fax:
Practice Address - Street 1:5426 ROLLING GREEN RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-6262
Practice Address - Country:US
Practice Address - Phone:214-527-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802650423171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor