Provider Demographics
NPI:1023813912
Name:FREEBURG, MIKE D
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:D
Last Name:FREEBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-0255
Mailing Address - Country:US
Mailing Address - Phone:402-206-4258
Mailing Address - Fax:
Practice Address - Street 1:2015 AVENUE B APT C10
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-1543
Practice Address - Country:US
Practice Address - Phone:402-206-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor