Healthcare Provider Details

I. General information

NPI: 1609316470
Provider Name (Legal Business Name): MR. MICHEAL LIONELL FREEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5426 ROLLING GREEN RD
ARLINGTON TX
76017-6262
US

IV. Provider business mailing address

5426 ROLLING GREEN RD
ARLINGTON TX
76017-6262
US

V. Phone/Fax

Practice location:
  • Phone: 214-527-4535
  • Fax:
Mailing address:
  • Phone: 214-527-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number802650423
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: