Provider Demographics
NPI:1659362531
Name:FRIEDMAN, PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
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 1:30200 TELEGRAPH RD
Mailing Address - Street 2:STE 179
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4502
Mailing Address - Country:US
Mailing Address - Phone:248-258-1919
Mailing Address - Fax:248-258-9624
Practice Address - Street 1:30200 TELEGRAPH RD
Practice Address - Street 2:STE 179
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4502
Practice Address - Country:US
Practice Address - Phone:248-258-1919
Practice Address - Fax:248-258-9624
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037834207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1272220Medicaid
06304117141Medicare ID - Type Unspecified
MI1272220Medicaid