Provider Demographics
NPI:1649207044
Name:FREIREICH, RONALD A (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:FREIREICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28790 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODMERE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4638
Mailing Address - Country:US
Mailing Address - Phone:216-591-1905
Mailing Address - Fax:216-591-1961
Practice Address - Street 1:28790 CHAGRIN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4638
Practice Address - Country:US
Practice Address - Phone:216-591-1905
Practice Address - Fax:216-591-1961
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002473213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0769413Medicaid
OHT34212Medicare UPIN
OHFR0662491Medicare PIN
OH0769413Medicaid
OHFR0662493Medicare PIN