Provider Demographics
NPI:1942265178
Name:FREELAND, RYAN DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DALE
Last Name:FREELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 GEZON PKWY SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9519
Mailing Address - Country:US
Mailing Address - Phone:616-893-6324
Mailing Address - Fax:616-243-3377
Practice Address - Street 1:1673 GEZON PKWY SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519
Practice Address - Country:US
Practice Address - Phone:616-893-6324
Practice Address - Fax:616-243-3377
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258010207N00000X
MI4301084275207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301084275OtherSTATE MEDICAL LICENSE