MEDICARE: ERWIN FRIEDMAN D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31603457	OTHER	IL	BLUE CROSS BLUE SHIELD #

General Provider Information

NPI Number	:	1063412617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERWIN FRIEDMAN D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 807
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60009-0807
Country	:	US
Telephone Number	:	847-437-9889
Fax Number	:	847-437-4149

Provider Business Practice Location Address
First Line	:	901 BIESTERFIELD RD
Second Line	:	SUITE 300
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3392
Country	:	US
Telephone Number	:	847-437-9889
Fax Number	:	847-437-4149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	11/14/2007

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