Healthcare Provider Details

I. General information

NPI: 1063077840
Provider Name (Legal Business Name): MICHAEL A FREEDMAN D.O. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 KING RD STE D
RIVERVIEW MI
48193-7952
US

IV. Provider business mailing address

14600 KING RD STE D
RIVERVIEW MI
48193-7952
US

V. Phone/Fax

Practice location:
  • Phone: 734-479-7310
  • Fax: 734-479-7307
Mailing address:
  • Phone: 734-479-7310
  • Fax: 734-479-7307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELE MORAN PARVIN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 734-479-7308