Healthcare Provider Details

I. General information

NPI: 1730884123
Provider Name (Legal Business Name): SYDNEY ARIEL FREEDMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 CALUMET AVE STE 203
MUNSTER IN
46321-2885
US

IV. Provider business mailing address

1801 W DIVISION ST APT 2N
CHICAGO IL
60622-8113
US

V. Phone/Fax

Practice location:
  • Phone: 219-228-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003982A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: