Provider Demographics
NPI:1912571191
Name:FRIEDL, EMILY ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ANN
Last Name:FRIEDL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 69TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5519
Mailing Address - Country:US
Mailing Address - Phone:262-945-4781
Mailing Address - Fax:937-641-5941
Practice Address - Street 1:DAYTON CHILDREN'S HOSPITAL
Practice Address - Street 2:1 CHILDREN'S PLAZA
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404
Practice Address - Country:US
Practice Address - Phone:937-641-3433
Practice Address - Fax:937-641-5941
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31-0672132Medicaid