Healthcare Provider Details

I. General information

NPI: 1114137015
Provider Name (Legal Business Name): BETHANY FREEDMAN PERI M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY D FREEDMAN

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N OAK AVE
MARSHFIELD WI
54449-5703
US

IV. Provider business mailing address

1000 N OAK AVE
MARSHFIELD WI
54449-5703
US

V. Phone/Fax

Practice location:
  • Phone: 715-389-0633
  • Fax:
Mailing address:
  • Phone: 715-387-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number82828-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: