Provider Demographics
NPI:1639104474
Name:FREESE, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:FREESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 DANA AVE SUITE 210
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207-2276
Mailing Address - Country:US
Mailing Address - Phone:513-351-1200
Mailing Address - Fax:513-351-1580
Practice Address - Street 1:2135 DANA AVE SUITE 210
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207
Practice Address - Country:US
Practice Address - Phone:513-351-1200
Practice Address - Fax:513-351-1580
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0404690OtherUHC
OH000000065218OtherANTHEM
OH311329395OtherHUMANA
OH311329395OtherHUMANA
OH110214511Medicare PIN
OH000000065218OtherANTHEM