Provider Demographics
NPI:1467451195
Name:FRIEDMAN, SHELDON J (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:J
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 1:3611 S REED RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3806
Mailing Address - Country:US
Mailing Address - Phone:765-864-6767
Mailing Address - Fax:765-864-6768
Practice Address - Street 1:3611 S REED RD
Practice Address - Street 2:SUITE 213
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3806
Practice Address - Country:US
Practice Address - Phone:765-864-6767
Practice Address - Fax:765-864-6768
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023474A246XC2901X
IN01023474207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100319290Medicaid
IN110229173OtherRAILROAD MEDICARE
IN247020GMedicare PIN
IN312150Medicare PIN
INP00408433Medicare PIN
IN110229173OtherRAILROAD MEDICARE
IN183380VMedicare PIN