Provider Demographics
NPI:1730138926
Name:FRIEDE, ROTEM (MD)
Entity Type:Individual
Prefix:
First Name:ROTEM
Middle Name:
Last Name:FRIEDE
Suffix:
Gender:F
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:DEPT 4931
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4931
Mailing Address - Country:US
Mailing Address - Phone:866-540-5303
Mailing Address - Fax:
Practice Address - Street 1:501 SOUTH 54TH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:215-748-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421881207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011308350001Medicaid
PA0014579300005Medicaid
PA1629003OtherHIGHMARK BLUE SHIELD
PA34928MD421881OtherHEALTH PARTNERS
PA30019161OtherKEYSTONE MERCY
PA0014579300005Medicaid
PA083780S52Medicare ID - Type Unspecified
PA1011308350001Medicaid