| NPI | 1013441930 |
|---|---|
| Doing Business As | FREESTATE |
| Entity Type | Organization |
| Authorized Contact | ELISHA YAGHMAI President 888-505-1776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: KS 04-33447) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-33447) |
| 208000000X Pediatrics (Licence: KS 04-33447) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2017-04-18 |