Provider Demographics
NPI:1396769717
Name:FREEMAN, MICHAEL BENTON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BENTON
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 1:1924 ALCOA HWY
Mailing Address - Street 2:U11
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-544-9295
Mailing Address - Fax:865-544-6361
Practice Address - Street 1:1940 ALCOA HWY
Practice Address - Street 2:SUITE 120 HEART LUNG VASCULAR INSTIUTE
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-544-8040
Practice Address - Fax:865-544-8041
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0180332086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3027402Medicaid
TN3027402Medicaid
C36356Medicare UPIN