Provider Demographics
NPI:1356969984
Name:FREEDOM WOUND PHYSICIANS PA
Entity type:Organization
Organization Name:FREEDOM WOUND PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAN
Authorized Official - Middle Name:PHAM
Authorized Official - Last Name:HULEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-252-7792
Mailing Address - Street 1:1 CHISHOLM TRAIL RD STE 215
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5094
Mailing Address - Country:US
Mailing Address - Phone:512-202-3830
Mailing Address - Fax:512-354-1106
Practice Address - Street 1:1 CHISHOLM TRAIL RD STE 215
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5094
Practice Address - Country:US
Practice Address - Phone:512-202-3830
Practice Address - Fax:512-354-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty