Healthcare Provider Details

I. General information

NPI: 1427545771
Provider Name (Legal Business Name): KALEB FREEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE
COLTON CA
92324-1819
US

IV. Provider business mailing address

PO BOX 2705
HUNTSVILLE AL
35804-2705
US

V. Phone/Fax

Practice location:
  • Phone: 567-274-7071
  • Fax:
Mailing address:
  • Phone: 256-265-4462
  • Fax: 256-265-4463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.2692
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number93499
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number311150
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: