1467451195 NPI number — DR. SHELDON J FRIEDMAN M.D.

Table of content: DR. SHELDON J FRIEDMAN M.D. (NPI 1467451195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467451195 NPI number — DR. SHELDON J FRIEDMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDMAN
Provider First Name:
SHELDON
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467451195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3611 S REED RD
Provider Second Line Business Mailing Address:
SUITE 213
Provider Business Mailing Address City Name:
KOKOMO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46902-3806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-864-6767
Provider Business Mailing Address Fax Number:
765-864-6768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3611 S REED RD
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
KOKOMO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46902-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-864-6767
Provider Business Practice Location Address Fax Number:
765-864-6768
Provider Enumeration Date:
07/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246XC2901X , with the licence number:  01023474A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 01023474 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100319290 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110229173 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".