Provider Demographics
NPI:1942479654
Name:DAVID A FRIEDMAN DPM PC
Entity Type:Organization
Organization Name:DAVID A FRIEDMAN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:AVERY
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-953-0155
Mailing Address - Street 1:37672 PROFESSIONAL CENTER DR
Mailing Address - Street 2:SUITE 150B
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1154
Mailing Address - Country:US
Mailing Address - Phone:734-953-0155
Mailing Address - Fax:734-953-0114
Practice Address - Street 1:37672 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE 150B
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1154
Practice Address - Country:US
Practice Address - Phone:734-953-0155
Practice Address - Fax:734-953-0114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID A FRIEDMAN DPM PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001103213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1629660Medicaid
MIT34334Medicare UPIN
MI1629660Medicaid