Provider Demographics
NPI:1649289190
Name:FREEDHEIM, CARRIE K (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:K
Last Name:FREEDHEIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6375E TANQUE VERDE RD 140
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3863
Mailing Address - Country:US
Mailing Address - Phone:520-885-4679
Mailing Address - Fax:520-296-9556
Practice Address - Street 1:6375E TANQUE VERDE RD 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3863
Practice Address - Country:US
Practice Address - Phone:520-885-4679
Practice Address - Fax:520-296-9556
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ267802084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG77698Medicare UPIN
AZ74466Medicare ID - Type Unspecified