1952388431 NPI number — KENNETH FRIEDMAN D.P.M.

Table of content: KENNETH FRIEDMAN D.P.M. (NPI 1952388431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952388431 NPI number — KENNETH FRIEDMAN D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDMAN
Provider First Name:
KENNETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1952388431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2835 W DE LEON ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33609-4168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-254-6592
Provider Business Mailing Address Fax Number:
813-254-3634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 N MCMULLEN BOOTH RD
Provider Second Line Business Practice Location Address:
SUITE A2-B
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33759-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-725-2719
Provider Business Practice Location Address Fax Number:
727-724-0729
Provider Enumeration Date:
12/27/2005

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: 213E00000X , with the licence number:  PO2098 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 65243 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2700455 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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