Healthcare Provider Details

I. General information

NPI: 1417997958
Provider Name (Legal Business Name): TIMOTHY J FREEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD STE 310
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

2845 GREENBRIER RD STE 310 PO BOX 8900
GREEN BAY WI
54303-2728
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8300
  • Fax: 920-288-8305
Mailing address:
  • Phone: 920-288-8300
  • Fax: 920-288-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number23051-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: