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General NPI Number Information
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NPI Number | 1609029214
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Entity Type | Organization
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Legal Business Name | LASHAWN D FREEMAN DPM SC
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 650 GRANT ST #4
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City | GARY
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State | IN
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Zip | 46404-1533
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Country | US
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Telephone | 219-882-2000
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Fax | 219-882-2044
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Provider Business Mailing Address
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Address Line | PO BOX 19468
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City | CHICAGO
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State | IL
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Zip | 60619-0468
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Country | US
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Telephone | 219-882-2000
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Fax | 219-881-2836
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Authorized Official
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Title or Position | OWNER
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Name | LASHAWN D FREEMAN
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Credential | DPM
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Telephone | 219-882-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 07001023A
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License Number State | IN
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