Provider Demographics
NPI:1427014455
Name:FRIEDLIN, FORREST J (DO)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:J
Last Name:FRIEDLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W 10TH ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3010
Mailing Address - Country:US
Mailing Address - Phone:317-423-5539
Mailing Address - Fax:317-423-5695
Practice Address - Street 1:410 W 10TH ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3010
Practice Address - Country:US
Practice Address - Phone:317-423-5539
Practice Address - Fax:317-423-5695
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02002974A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC55034Medicare UPIN
IN715530ADDMedicare ID - Type Unspecified