MEDICARE: DR. IRA FREILICH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	ME 46912	FL
2	207ND0900X	Dermatopathology Physician	ME 46912	FL
3	207NS0135X	Procedural Dermatology Physician	ME 46912	FL
4	207Q00000X	Family Medicine Physician	ME 46912	FL
5	208D00000X	General Practice Physician	ME 46912	FL
6	207ND0101X	MOHS-Micrographic Surgery Physician	ME 46912	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427081496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA FREILICH MD

Provider Business Mailing Address
First Line	:	2505 HARRISON AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4464
Country	:	US
Telephone Number	:	850-233-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	1474 MARKET ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1768
Country	:	US
Telephone Number	:	850-233-3376
Fax Number	:	850-522-8354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/28/2020

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Directions to “ DR. IRA FREILICH MD” Practice Location

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