Provider Demographics
NPI:1356557698
Name:FRIEDMAN, ERIN LANE (DO)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:LANE
Last Name:FRIEDMAN
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 1:60 REGENCY PL
Mailing Address - Street 2:
Mailing Address - City:MILLSTADT
Mailing Address - State:IL
Mailing Address - Zip Code:62260-2210
Mailing Address - Country:US
Mailing Address - Phone:618-476-3373
Mailing Address - Fax:618-476-1890
Practice Address - Street 1:60 REGENCY PL
Practice Address - Street 2:
Practice Address - City:MILLSTADT
Practice Address - State:IL
Practice Address - Zip Code:62260-2210
Practice Address - Country:US
Practice Address - Phone:618-476-3373
Practice Address - Fax:618-476-1890
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131014207R00000X
IL036-131014207RN0300X, 207R00000X
MI5101016684207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110E006331OtherBCBS GROUP NUMBER
MI1538392378OtherGROUP NPI NUMBER
MI110E006331OtherBCBS GROUP NUMBER
MI1538392378OtherGROUP NPI NUMBER