1477756708 NPI number — NEIL R FRIEDMAN MD LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477756708 NPI number — NEIL R FRIEDMAN MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIL R FRIEDMAN MD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477756708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4711 W GOLF ROAD
Provider Second Line Business Mailing Address:
SUITE 910
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60076-1247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-673-6505
Provider Business Mailing Address Fax Number:
847-673-6334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
767 PARK AVENUE WEST
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-432-4066
Provider Business Practice Location Address Fax Number:
847-673-6334
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEDMAN
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
847-673-6505

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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