Provider Demographics
NPI:1427060888
Name:FRIED, NEIL R (DPM)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:R
Last Name:FRIED
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 1:15921 HOMETOWN DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586
Mailing Address - Country:US
Mailing Address - Phone:815-341-2084
Mailing Address - Fax:815-609-5605
Practice Address - Street 1:15921 HOMETOWN DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586
Practice Address - Country:US
Practice Address - Phone:815-341-2084
Practice Address - Fax:815-609-5605
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004689213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004689Medicaid
IL560760004Medicare PIN
ILP00735382Medicare PIN
ILU45395Medicare UPIN
IL753600002Medicare PIN
IL560750003Medicare PIN
IL560770002Medicare PIN
ILK25417Medicare PIN