Healthcare Provider Details

I. General information

NPI: 1013955848
Provider Name (Legal Business Name): MARTIN L FREEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S 8TH ST STE 250
MINNEAPOLIS MN
55404-1208
US

IV. Provider business mailing address

720 WASHINGTON AVE SE UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55414-2924
US

V. Phone/Fax

Practice location:
  • Phone: 612-347-6450
  • Fax:
Mailing address:
  • Phone: 612-884-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number26713
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: