Healthcare Provider Details

I. General information

NPI: 1770140006
Provider Name (Legal Business Name): JULIAN JAY FREEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 1ST ST. SUITE 263
HIGHLAND PARK IL
60035
US

IV. Provider business mailing address

181 BERRY RD
NEW DURHAM NH
03855-2416
US

V. Phone/Fax

Practice location:
  • Phone: 847-433-7030
  • Fax:
Mailing address:
  • Phone: 847-433-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number036051225
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036051225
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036051225
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: