Provider Demographics
NPI:1821166810
Name:FRIEND, GARY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:FRIEND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 COMPASS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8000
Mailing Address - Country:US
Mailing Address - Phone:847-729-9580
Mailing Address - Fax:847-729-9480
Practice Address - Street 1:2501 COMPASS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8000
Practice Address - Country:US
Practice Address - Phone:847-729-9580
Practice Address - Fax:847-729-9480
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002959213ES0103X
IL178-001404101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00114871OtherRAILROAD MEDICARE
ILT35536Medicare UPIN
ILK07163Medicare ID - Type Unspecified