Provider Information for 1093199713
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SHELL FREEMAN
Sex: Female
NPI: 1093199713
Last Updated: 2022-01-03
Certification Date: 2022-01-03
Certification Date: 2022-01-03
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1093199713 | ||||||||||||
| Enumeration Date | 2015-07-13 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 618 CHRYSLER DR APT 201 DETROIT, MI 48207-3055 United States Phone: 313-778-2532 | Fax: | ||||||||||||
| Primary Practice Address | 14799 DIX TOLEDO RD SOUTHGATE, MI 48195-2507 United States Phone: 734-324-8326 | Fax: | ||||||||||||
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