Provider Demographics
NPI:1700874823
Name:FREIMARK, MICHAEL JAY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:FREIMARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4100 S HOSPITAL DR STE 302
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2838
Mailing Address - Country:US
Mailing Address - Phone:954-321-1591
Mailing Address - Fax:954-321-1592
Practice Address - Street 1:4100 S HOSPITAL DR STE 302
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2838
Practice Address - Country:US
Practice Address - Phone:954-321-1591
Practice Address - Fax:951-321-1592
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2022-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME63672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF69222OtherUPIN
FL372937100Medicaid