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General NPI Number Information
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NPI Number | 1649566829
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Entity Type | Individual
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Provider Name | LORI MICHELE FREETAGE DO
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Gender | Female
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Dates
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Enumeration Date | 06/25/2011
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 3535 SOUTHERN BLVD
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City | DAYTON
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State | OH
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Zip | 45429-1221
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Country | US
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Telephone | 201-741-8875
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Fax |
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Provider Business Mailing Address
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Address Line | 3451 NEWMARK DR
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City | MIAMISBURG
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State | OH
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Zip | 45342-5426
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Country | US
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Telephone | 201-741-8875
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | OS16627
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 34.014266
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License Number State | OH
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