Basic Information
| Provider Information | |||||||||
| NPI: | 1295921948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | WIYATTA | ||||||||
| MiddleName: | BENDU | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11914 ASTORIA BLVD STE 510 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770896050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134867680 | ||||||||
| FaxNumber: | 7134869301 | ||||||||
| Practice Location | |||||||||
| Address1: | 11914 ASTORIA BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770896064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134867680 | ||||||||
| FaxNumber: | 7134869301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2007 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | M8656 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.