Provider Demographics
NPI:1184614653
Name:FREEL, DOUGLAS JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOHN
Last Name:FREEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3027
Mailing Address - Country:US
Mailing Address - Phone:217-222-6550
Mailing Address - Fax:
Practice Address - Street 1:1118 HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3027
Practice Address - Country:US
Practice Address - Phone:217-222-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000712213ES0131X
IL016-003720213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1184614653Medicaid
IL00132005OtherBLUE CROSS/BLUE SHIELD
3074226001OtherCIGNA
009464OtherHEALTH ALLIANCE
127214OtherHEALTHLINK
MO1184614653Medicaid
IL4544460001Medicare NSC
ILL92214Medicare PIN
ILF400164058Medicare PIN
IL00132005OtherBLUE CROSS/BLUE SHIELD
IL4544460003Medicare NSC
T38187Medicare UPIN
IL202116Medicare ID - Type UnspecifiedGROUP
480034054Medicare ID - Type UnspecifiedRAILROAD