Provider Demographics
NPI:1417953886
Name:FRIEDMAN, IDO (DPM)
Entity Type:Individual
Prefix:DR
First Name:IDO
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 SAINT JULIAN PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2410
Mailing Address - Country:US
Mailing Address - Phone:803-256-6776
Mailing Address - Fax:803-256-6778
Practice Address - Street 1:910 E 70TH ST STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4831
Practice Address - Country:US
Practice Address - Phone:912-596-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC524213E00000X
GA847213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000812644JMedicaid
GA000812644IMedicaid
GAU73444Medicare UPIN
GA48SCCJKMedicare PIN
GA000812644JMedicaid