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General NPI Number Information
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NPI Number | 1790949097
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Entity Type | Individual
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Provider Name | MARCUS KYLE FREE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 10/27/2019
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Provider Practice Location Address
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Address Line | 2143 DERFLA DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-9661
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Country | US
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Telephone | 888-550-5154
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Fax | 888-414-4545
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Provider Business Mailing Address
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Address Line | 2143 DERFLA DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-9661
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Country | US
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Telephone | 810-404-2521
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Fax | 888-414-4545
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301093347
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | L0799
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301093347
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | LO799
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License Number State | TX
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