Provider Demographics
NPI:1346217445
Name:FRIEDMAN, GERALD ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ALAN
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GERALD
Other - Middle Name:ALAN
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13326 N BLVD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-1514
Mailing Address - Country:US
Mailing Address - Phone:269-649-2321
Mailing Address - Fax:
Practice Address - Street 1:13326 N BLVD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-1514
Practice Address - Country:US
Practice Address - Phone:269-649-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043834207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010C96065OtherBCBS
MI1417961137OtherBCBSM - BRONSON VICKSBURG OUTPATIENT CENTER
MI1346217445Medicaid
MI3209495Medicaid
MIC20578OtherRAILROAD MEDICARE
MIC20578OtherRAILROAD MEDICARE
MIB46156Medicare UPIN
MI3209495Medicaid