Provider Demographics
NPI:1417232125
Name:FRIEDMAN, EMILY BETH (PA-C)
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:BETH
Last Name:FRIEDMAN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1658
Mailing Address - Country:US
Mailing Address - Phone:847-535-6150
Mailing Address - Fax:847-535-7801
Practice Address - Street 1:1000 N WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1658
Practice Address - Country:US
Practice Address - Phone:847-535-6150
Practice Address - Fax:847-535-7801
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011010363A00000X
PAMA065297363A00000X
NY027823363A00000X
OH50.007875RX363A00000X
FLPAT9106199363A00000X
IL085-006215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004142000Medicaid