Provider Demographics
NPI:1184638868
Name:FRIEND, CHARLES R (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:FRIEND
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-3833
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1640 CRAWFORDSVILLE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3800
Practice Address - Country:US
Practice Address - Phone:765-362-5789
Practice Address - Fax:765-362-2453
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10246207Q00000X
IN02001804A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200528320Medicaid
FL14150OtherBCBS
INP01368092OtherRAIL ROAD MEDICARE
IN000000891732OtherANTHEM
IN201246920Medicaid
IN000000371599OtherANTHEM
FL280728900Medicaid
FL5517084OtherAETNA
FL14150OtherBCBS
INH12272Medicare UPIN
FL280728900Medicaid
FLAJ036ZMedicare PIN