Provider Demographics
NPI:1144226762
Name:FRYDMAN, JOSEPH E (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:E
Last Name:FRYDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2634 GRAND AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2460
Mailing Address - Country:US
Mailing Address - Phone:847-336-7797
Mailing Address - Fax:847-336-9860
Practice Address - Street 1:2634 GRAND AVE
Practice Address - Street 2:STE 201
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2460
Practice Address - Country:US
Practice Address - Phone:847-336-7797
Practice Address - Fax:847-336-9860
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C41256Medicare UPIN
456201Medicare ID - Type Unspecified