Provider Demographics
NPI:1760156046
Name:SHAENA FREEMAN, MD PLLC
Entity Type:Organization
Organization Name:SHAENA FREEMAN, MD PLLC
Other - Org Name:MACATAWA FAMILY MEDICINE, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:EDDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-393-8100
Mailing Address - Street 1:1061 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-5216
Mailing Address - Country:US
Mailing Address - Phone:616-393-8100
Mailing Address - Fax:
Practice Address - Street 1:1061 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-5216
Practice Address - Country:US
Practice Address - Phone:616-393-8100
Practice Address - Fax:877-451-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900149064OtherPRIORITY HEALTH