Provider Demographics
NPI:1003945320
Name:FRIEDL, CHARLES ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANDREW
Last Name:FRIEDL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S FINLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4837
Mailing Address - Country:US
Mailing Address - Phone:630-819-5600
Mailing Address - Fax:
Practice Address - Street 1:2050 S FINLEY RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4837
Practice Address - Country:US
Practice Address - Phone:630-819-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL400480OtherGROUP MEDICARE PTAN
CN4921OtherRRMC