Healthcare Provider Details

I. General information

NPI: 1649207044
Provider Name (Legal Business Name): RONALD A FREIREICH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28790 CHAGRIN BLVD SUITE 200
WOODMERE OH
44122-4638
US

IV. Provider business mailing address

28790 CHAGRIN BLVD SUITE 200
WOODMERE OH
44122-4638
US

V. Phone/Fax

Practice location:
  • Phone: 216-591-1905
  • Fax: 216-591-1961
Mailing address:
  • Phone: 216-591-1905
  • Fax: 216-591-1961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002473
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: