Provider Demographics
NPI:1265673396
Name:FRIEDBERG, MICHAEL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:FRIEDBERG
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 1:1671 S SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2623
Mailing Address - Country:US
Mailing Address - Phone:303-955-1608
Mailing Address - Fax:
Practice Address - Street 1:1671 S SHERMAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2623
Practice Address - Country:US
Practice Address - Phone:303-955-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-047442208600000X
MO2002010044208600000X
KY38270208600000X
CO47178208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2002010044OtherDEPARTMENT OF ECONOMIC DEVELOPMENT, DIVISON OF PROFESSINAL REGISTRATION
IL036-047442OtherDEPARTMENT OF FINANCIAL AND PROFESSINAL REGISTRATION
CO47178OtherDEPARTMENT OF REGULATORY AGENCIES, DIVISION OF REISTRATIONS
KS38270OtherKENTUCKY BOARD OF MEDICAL LICENSURE