Provider Demographics
NPI:1972692135
Name:LASHAWN D FREEMAN DPM SC
Entity type:Organization
Organization Name:LASHAWN D FREEMAN DPM SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-363-5523
Mailing Address - Street 1:PO BOX 19468
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-0468
Mailing Address - Country:US
Mailing Address - Phone:773-363-5523
Mailing Address - Fax:773-363-5602
Practice Address - Street 1:1525 E 53RD ST
Practice Address - Street 2:SUITE 816
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4557
Practice Address - Country:US
Practice Address - Phone:773-363-5523
Practice Address - Fax:773-363-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005098213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDD6800OtherRAILROAD MEDICARE
IL0001633214OtherBLUE CROSS BLUE SHIELD
IL5075990001Medicare NSC
ILDD6800OtherRAILROAD MEDICARE
IL208818Medicare PIN