Provider Demographics
NPI:1679583520
Name:FREEDMAN, MARVIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:FREEDMAN
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 1:277 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1225
Mailing Address - Country:US
Mailing Address - Phone:847-835-0277
Mailing Address - Fax:847-835-0277
Practice Address - Street 1:277 SYLVAN RD
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1225
Practice Address - Country:US
Practice Address - Phone:847-835-0277
Practice Address - Fax:847-835-0277
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360352902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
712300Medicare ID - Type Unspecified