Provider Demographics
NPI:1154485811
Name:FRIEDMAN, SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772081
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2022
Mailing Address - Country:US
Mailing Address - Phone:734-282-7266
Mailing Address - Fax:734-282-0353
Practice Address - Street 1:17171 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193
Practice Address - Country:US
Practice Address - Phone:734-282-7266
Practice Address - Fax:734-282-0353
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009867207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1154485811Medicaid
MIN98090001Medicare PIN
MI070H222200OtherBCBS