Healthcare Provider Details

I. General information

NPI: 1750506028
Provider Name (Legal Business Name): ANDREW GLEN FREEMAN MD, MS, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 CORPORATE PARK DR STE 132
CINCINNATI OH
45242-3300
US

IV. Provider business mailing address

8170 CORPORATE PARK DR STE 132
CINCINNATI OH
45242-3300
US

V. Phone/Fax

Practice location:
  • Phone: 513-202-3733
  • Fax: 888-303-2914
Mailing address:
  • Phone: 513-202-3733
  • Fax: 888-303-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35068500
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: