Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 7733 | IA |
NPI | 1073687323 |
---|---|
Provider Name | Dr. Michael Paul Freeseman |
First Address | Waterloo, IA 50702-2141 |
Second Address | Waterloo, IA 50702-2141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007948 | (05) | IA |