Provider Demographics
NPI:1447704507
Name:RONALD E. FREILICH DPM LLC
Entity type:Organization
Organization Name:RONALD E. FREILICH DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ETHAN
Authorized Official - Last Name:FREILICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-575-5112
Mailing Address - Street 1:25107 CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:JONESBURG
Mailing Address - State:MO
Mailing Address - Zip Code:63351-2454
Mailing Address - Country:US
Mailing Address - Phone:636-488-3321
Mailing Address - Fax:
Practice Address - Street 1:25107 CHEROKEE LN
Practice Address - Street 2:
Practice Address - City:JONESBURG
Practice Address - State:MO
Practice Address - Zip Code:63351-2454
Practice Address - Country:US
Practice Address - Phone:636-488-3321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015014633213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty