Provider Demographics
NPI:1366416430
Name:FRIEDMAN, PAUL BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRUCE
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14555 LEVAN RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5083
Mailing Address - Country:US
Mailing Address - Phone:734-462-1525
Mailing Address - Fax:734-462-1830
Practice Address - Street 1:14555 LEVAN RD
Practice Address - Street 2:SUITE 307
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5083
Practice Address - Country:US
Practice Address - Phone:734-462-1525
Practice Address - Fax:734-462-1830
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057638208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2833102Medicaid
MIB9740OtherMCARE INDIVIDUAL PIN#
MI02-0826302-2OtherBCBSM INDIVIDUAL PIN#
MI020H263670OtherBCBSM GROUP PIN#
MIH26367004Medicare ID - Type Unspecified
MI020H263670OtherBCBSM GROUP PIN#