Provider Demographics
NPI:1063412617
Name:FRIEDMAN, ERWIN (DPM)
Entity type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60009-0807
Mailing Address - Country:US
Mailing Address - Phone:847-437-9889
Mailing Address - Fax:847-437-4149
Practice Address - Street 1:901 BIESTERFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3392
Practice Address - Country:US
Practice Address - Phone:847-437-9889
Practice Address - Fax:847-437-4149
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603457OtherBLUE CROSS BLUE SHIELD #
ILK19420Medicare PIN
ILT37363Medicare UPIN
IL212020Medicare PIN
IL31603457OtherBLUE CROSS BLUE SHIELD #