Provider Demographics
NPI:1396918017
Name:FREIRE, MAXIME (MD)
Entity type:Individual
Prefix:
First Name:MAXIME
Middle Name:
Last Name:FREIRE
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 1:21125 SHELBURNE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1946
Mailing Address - Country:US
Mailing Address - Phone:216-219-1080
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # A21
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-4500
Practice Address - Country:US
Practice Address - Phone:800-223-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS769-L2085R0202X
OH57.0114022085R0202X
MS214272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01189939OtherRAILROAD MEDICARE PTAN
AL158937Medicaid
MS06395191Medicaid
MSP01189939OtherRAILROAD MEDICARE PTAN
MS06395191Medicaid
MS302I309418Medicare PIN
MS302I305644Medicare PIN