Provider Demographics
NPI:1316927510
Name:FRIEDMAN, JACQUELINE ANN (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31505 32 MILE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-5215
Mailing Address - Country:US
Mailing Address - Phone:586-727-2761
Mailing Address - Fax:586-727-3120
Practice Address - Street 1:31505 32 MILE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-5215
Practice Address - Country:US
Practice Address - Phone:586-727-2761
Practice Address - Fax:586-727-3120
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1134265986Medicaid
H67701OtherHEALTH ALLIANCE PLAN
H67701OtherHEALTH ALLIANCE PLAN