Provider Demographics
NPI:1932180189
Name:FREEMAN-HILDRETH, YOLONDA FAYE (PA)
Entity Type:Individual
Prefix:
First Name:YOLONDA
Middle Name:FAYE
Last Name:FREEMAN-HILDRETH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:YOLONDA
Other - Middle Name:FAYE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:PMOB #200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-465-3144
Mailing Address - Fax:248-465-3146
Practice Address - Street 1:16001 WEST NINE MILE ROAD
Practice Address - Street 2:DEPT OF INTERNAL MEDICINE
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48275-4818
Practice Address - Country:US
Practice Address - Phone:248-849-3152
Practice Address - Fax:248-849-5378
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004213363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF36477146Medicare PIN