Provider Demographics
NPI:1295809705
Name:FRIED, STEVEN T (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:T
Last Name:FRIED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:40000 WEST EIGHT MILE ROAD
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167
Mailing Address - Country:US
Mailing Address - Phone:248-380-6200
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:40000 WEST EIGHT MILE ROAD
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167
Practice Address - Country:US
Practice Address - Phone:248-380-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SF083049OtherCHAMPUS-CHAMPUS
080H262390OtherBLUE CROSS-BLUE CROSS
SF083049OtherCOMMERCIAL-COMMERCIAL NUMBER
MI462076610Medicaid
0H26239171Medicare ID - Type Unspecified
SF083049OtherCHAMPUS-CHAMPUS