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General NPI Number Information
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NPI Number | 1447704507
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Entity Type | Organization
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Legal Business Name | RONALD E. FREILICH DPM LLC
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Dates
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Enumeration Date | 08/06/2016
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Last Update Date | 08/06/2016
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Provider Practice Location Address
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Address Line | 25107 CHEROKEE LN
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City | JONESBURG
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State | MO
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Zip | 63351-2454
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Country | US
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Telephone | 636-488-3321
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Fax |
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Provider Business Mailing Address
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Address Line | 25107 CHEROKEE LN
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City | JONESBURG
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State | MO
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Zip | 63351-2454
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Country | US
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Telephone | 636-488-3321
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. RONALD ETHAN FREILICH
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Credential | D.P.M.
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Telephone | 314-575-5112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 2015014633
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License Number State | MO
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