Healthcare Provider Details

I. General information

NPI: 1073445631
Provider Name (Legal Business Name): EBONI FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24200 WOODWARD AVE
PLEASANT RIDGE MI
48069-1142
US

IV. Provider business mailing address

21700 EVERGREEN ST
SAINT CLAIR SHORES MI
48082-1935
US

V. Phone/Fax

Practice location:
  • Phone: 248-547-2668
  • Fax:
Mailing address:
  • Phone: 313-405-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: