Healthcare Provider Details

I. General information

NPI: 1134183916
Provider Name (Legal Business Name): KENDAL T FREEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W 203RD ST SUITE 201
OLYMPIA FIELDS IL
60461-1180
US

IV. Provider business mailing address

1040 SIERRA DR SUITE 400
GREENWOOD IN
46143-7240
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-2880
  • Fax: 708-503-3295
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036101263
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: