Provider Demographics
NPI:1760470215
Name:FRIEDMAN, SUSAN JOYCE (PA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JOYCE
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JOYCE
Other - Last Name:DUBRINSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT CH 17876
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-0001
Mailing Address - Country:US
Mailing Address - Phone:248-893-3200
Mailing Address - Fax:248-893-2950
Practice Address - Street 1:28455 HAGGERTY RD
Practice Address - Street 2:STE 200
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2982
Practice Address - Country:US
Practice Address - Phone:248-893-3200
Practice Address - Fax:248-893-2950
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P18717Medicare UPIN
MIN29180P01Medicare ID - Type Unspecified