Provider Demographics
NPI:1639112261
Name:FREEMAN, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:FREEMAN
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 1:2750 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5519
Mailing Address - Country:US
Mailing Address - Phone:352-732-7779
Mailing Address - Fax:352-732-2664
Practice Address - Street 1:2750 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5519
Practice Address - Country:US
Practice Address - Phone:352-732-7779
Practice Address - Fax:352-732-2664
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27682207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME27682OtherSTATE LICENSE NUMBER
FLAF7013965OtherDEA
FLME27682OtherSTATE LICENSE NUMBER
42114ZMedicare PIN