Provider Demographics
NPI:1053428045
Name:FRECKLETON, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FRECKLETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15123 CHINQUAPIN
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023
Mailing Address - Country:US
Mailing Address - Phone:210-887-4321
Mailing Address - Fax:
Practice Address - Street 1:7909 FREDERICKSBURG RD
Practice Address - Street 2:SUITE #127
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3425
Practice Address - Country:US
Practice Address - Phone:210-614-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ74882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104056003Medicaid
TX104056004OtherCIDC
TX104056004OtherCIDC
TX104056003Medicaid