Provider Demographics
NPI:1104930593
Name:FREE, MICHAEL C (RPA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:FREE
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 TITUS PLACE
Mailing Address - Street 2:EMERGENCY DEPT.
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856
Mailing Address - Country:US
Mailing Address - Phone:607-865-2189
Mailing Address - Fax:845-565-3395
Practice Address - Street 1:1 TITUS PLACE
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856
Practice Address - Country:US
Practice Address - Phone:607-865-2189
Practice Address - Fax:845-565-3395
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004868363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS51696Medicare UPIN
NYZ87631Medicare ID - Type Unspecified