Provider Demographics
NPI:1134183916
Name:FREEMAN, KENDAL T (MD)
Entity type:Individual
Prefix:
First Name:KENDAL
Middle Name:T
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-8319
Practice Address - Street 1:3700 W 203RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1180
Practice Address - Country:US
Practice Address - Phone:708-679-2880
Practice Address - Fax:708-503-3295
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101263207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101263Medicaid
ILL95614Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 16
ILL95615Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 15
IL036101263Medicaid