Provider Demographics
NPI:1104881218
Name:FRYDMAN, JAMES D (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:FRYDMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-695-0665
Mailing Address - Fax:312-695-0050
Practice Address - Street 1:800 N WESTMORELAND RD
Practice Address - Street 2:SUITE 205
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1673
Practice Address - Country:US
Practice Address - Phone:847-234-4310
Practice Address - Fax:847-234-4336
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-06-23
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Provider Licenses
StateLicense IDTaxonomies
IL036124637208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2760720 00Medicaid
FLAE679YMedicare PIN