Provider Demographics
NPI:1023117769
Name:MICHAEL J. FREEDMAN, MD, P.C.
Entity type:Organization
Organization Name:MICHAEL J. FREEDMAN, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-351-0011
Mailing Address - Street 1:24725 W 12 MILE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1801
Mailing Address - Country:US
Mailing Address - Phone:248-351-0011
Mailing Address - Fax:248-351-0017
Practice Address - Street 1:24725 W 12 MILE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1801
Practice Address - Country:US
Practice Address - Phone:248-351-0011
Practice Address - Fax:248-351-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMF0287382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1373563Medicaid
MI2606303270OtherBCBSM
MIMF028738OtherLICENSE NUMBER
MIMF028738OtherLICENSE NUMBER
MI0630327Medicare ID - Type UnspecifiedMEDICARE ID