MEDICARE: LOUIS ISRAEL FREEMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019017492	IL

General Provider Information

NPI Number	:	1134405947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS ISRAEL FREEMAN D.D.S.

Provider Business Mailing Address
First Line	:	7923 LINCOLN AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3615
Country	:	US
Telephone Number	:	847-675-7040
Fax Number	:	847-675-4335

Provider Business Practice Location Address
First Line	:	7923 LINCOLN AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3615
Country	:	US
Telephone Number	:	847-675-7040
Fax Number	:	847-675-4335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	10/25/2011

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