Provider Demographics
NPI:1508950593
Name:FRIEDLI, JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FRIEDLI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3768
Mailing Address - Country:US
Mailing Address - Phone:715-685-7500
Mailing Address - Fax:
Practice Address - Street 1:1625 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3768
Practice Address - Country:US
Practice Address - Phone:715-685-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003697363A00000X
WI1406-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1508950593Medicaid
WI419646000Medicaid
WI419646000Medicaid
WI009904001Medicare PIN
MION74180Medicare ID - Type Unspecified
MIP00041338Medicare ID - Type UnspecifiedRAILROAD