# FREEMAN TICHATONGA CHANGAMIRE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1639377963
- **Gender:** Man
- **Credential:** M.D., SC.D., MBA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 244111 | MA | — |
| 207Q00000X | Family Medicine Physician | 38679 | SC | — |
| 207Q00000X | Family Medicine Physician | 50191 | KY | Yes |

## Other

- **Enumeration date:** 07/09/2007
- **Last updated:** 12/26/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000001121829 | ANTHEM-KY | KY |
| 05 | — | 110086725/A | — | MA |
| 01 | — | 234001 | SIHO | KY |
| 05 | — | 386790 | — | SC |
| 01 | — | K231120 | MEDICARE | KY |