Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | IL | |
Y | 222Z00000X | Podiatrist | IL |
NPI | 1063412617 |
---|---|
Provider Name | Erwin Friedman |
First Address | Elk Grove Village, IL 60009-0807 |
Second Address | Elk Grove Village, IL 60007-3392 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 14/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31603457 | BLUE CROSS BLUE SHIELD # (01) | IL |
T37363 | (02) | IL |