Healthcare Provider Details

I. General information

NPI: 1306848817
Provider Name (Legal Business Name): MARK EDWARD FREEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103A SOUTHPOINTE DR STE A
EDWARDSVILLE IL
62025-3651
US

IV. Provider business mailing address

103 SOUTHPOINTE DR STE A
EDWARDSVILLE IL
62025-3780
US

V. Phone/Fax

Practice location:
  • Phone: 618-656-2000
  • Fax: 618-656-1169
Mailing address:
  • Phone: 618-656-2000
  • Fax: 618-656-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036086072
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: