Provider Demographics
NPI:1750564845
Name:ROGER L. FRIEDMAN DPM
Entity type:Organization
Organization Name:ROGER L. FRIEDMAN DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-934-8444
Mailing Address - Street 1:5321 MEADOW LANE CT
Mailing Address - Street 2:SUITE 22
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-0600
Mailing Address - Country:US
Mailing Address - Phone:440-934-8444
Mailing Address - Fax:440-934-8447
Practice Address - Street 1:5321 MEADOW LANE CT
Practice Address - Street 2:SUITE 22
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-0600
Practice Address - Country:US
Practice Address - Phone:440-934-8444
Practice Address - Fax:440-934-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1205899887OtherINDIVIDUAL NPI
OHU41353Medicare UPIN
OH4777020001Medicare NSC