Healthcare Provider Details

I. General information

NPI: 1205995602
Provider Name (Legal Business Name): MICHAEL SEAN FREEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 ELM LANE SUITE 101
CHARLOTTE NC
28277
US

IV. Provider business mailing address

11220 ELM LANE SUITE 101
CHARLOTTE NC
28277
US

V. Phone/Fax

Practice location:
  • Phone: 704-543-1110
  • Fax: 704-543-0898
Mailing address:
  • Phone: 704-543-1110
  • Fax: 704-543-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number32239
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: