MEDICARE: MR. MICHEAL LIONELL FREEMAN

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	171W00000X	Contractor	802650423	TX

General Provider Information

NPI Number	:	1609316470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHEAL LIONELL FREEMAN

Provider Business Mailing Address
First Line	:	5426 ROLLING GREEN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-6262
Country	:	US
Telephone Number	:	214-527-4535
Fax Number	:

Provider Business Practice Location Address
First Line	:	5426 ROLLING GREEN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-6262
Country	:	US
Telephone Number	:	214-527-4535
Fax Number	:

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

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	04/26/2026

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