Individual
MARY JO FREEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
425 PINE RIDGE BLVD, SUITE 305B, WAUSAU, WI 54401-4123
(715) 847-2036
Mailing address
PO BOX 8004, WAUSAU, WI 54402-8004
(715) 847-2304
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20821
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30260300
—
WI
Enumeration date
07/17/2006
Last updated
07/15/2009
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