Healthcare Provider Details

I. General information

NPI: 1952388431
Provider Name (Legal Business Name): KENNETH FRIEDMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N MCMULLEN BOOTH RD SUITE A2-B
CLEARWATER FL
33759-2130
US

IV. Provider business mailing address

2835 W DE LEON ST SUITE 101
TAMPA FL
33609-4168
US

V. Phone/Fax

Practice location:
  • Phone: 727-725-2719
  • Fax: 727-724-0729
Mailing address:
  • Phone: 813-254-6592
  • Fax: 813-254-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2098
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: