Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2301002129 | MI |
N | 111NR0200X | Radiology | 84 | MI |
N | 213ER0200X | Radiology | 84 | MI |
NPI | 1669532156 |
---|---|
Provider Name | Dr. James Reilly Freas |
First Address | Dearborn, MI 48124-1713 |
Second Address | Dearborn, MI 48124-1713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
950H25060 | BCBSM (01) | MI |