=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700139243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LASHAWN D FREEMAN, DPM SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2012
-----------------------------------------------------
Last Update Date | 10/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1212 N BROAD ST
-----------------------------------------------------
City | GRIFFITH
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46319-1534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-972-9000
-----------------------------------------------------
Fax | 219-838-4521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1212 N BROAD ST
-----------------------------------------------------
City | GRIFFITH
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46319-1534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-972-9000
-----------------------------------------------------
Fax | 219-838-4521
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LASHAWN D FREEMAN
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 219-882-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 07001023A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------