Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO1375 | FL |
NPI | 1366417370 |
---|---|
Provider Name | Michael L Friedman |
First Address | Callahan, FL 32011 |
Second Address | Callahan, FL 32011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 02/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340517600 | (05) | FL |
T55524 | (02) | FL |