Provider Demographics
NPI:1164620530
Name:FRIEDMAN, ERIC G (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 W LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-5531
Mailing Address - Country:US
Mailing Address - Phone:219-464-3937
Mailing Address - Fax:219-462-1534
Practice Address - Street 1:552 W LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-5531
Practice Address - Country:US
Practice Address - Phone:219-464-3937
Practice Address - Fax:219-462-1534
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028202207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100208400AMedicaid
000000102346OtherANTHEM
IN653670AMedicare PIN
IND69788Medicare UPIN
IN100208400AMedicaid