Healthcare Provider Details

I. General information

NPI: 1649346032
Provider Name (Legal Business Name): BRIDGET FREEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/12/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEMOPHILIA OUTREACH CENTER 2060 BELLEVUE ST
GREEN BAY WI
54311
US

IV. Provider business mailing address

1826 TIERRA VERDE DR
ATLANTIC BEACH FL
32233-4527
US

V. Phone/Fax

Practice location:
  • Phone: 920-965-0606
  • Fax:
Mailing address:
  • Phone: 715-587-4904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberEL151023
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301091783
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLT3572
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME53299
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42713
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number68402
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: