Provider Demographics
NPI:1558356816
Name:FRIEDLANDER, JASON R (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:FRIEDLANDER
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 1:3805B SPRING ST STE 130
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1642
Mailing Address - Country:US
Mailing Address - Phone:262-631-8750
Mailing Address - Fax:262-631-8754
Practice Address - Street 1:3805B SPRING ST STE 130
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1642
Practice Address - Country:US
Practice Address - Phone:262-631-8750
Practice Address - Fax:262-631-8754
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32627700Medicaid
WI32627700Medicaid