Healthcare Provider Details

I. General information

NPI: 1598772808
Provider Name (Legal Business Name): MITCHELL J FREED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 505
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

2501 N ORANGE AVE SUITE 505
ORLANDO FL
32804-4603
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-2924
  • Fax: 407-894-5387
Mailing address:
  • Phone: 407-898-2924
  • Fax: 407-894-5387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME0053196
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: