Healthcare Provider Details

I. General information

NPI: 1053321836
Provider Name (Legal Business Name): JOHN ARTHUR FRIEDMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE SUITE 1828
CHICAGO IL
60602-3402
US

IV. Provider business mailing address

30 N MICHIGAN AVE SUITE 1828
CHICAGO IL
60602-3402
US

V. Phone/Fax

Practice location:
  • Phone: 312-750-9064
  • Fax: 312-750-9147
Mailing address:
  • Phone: 312-750-9064
  • Fax: 312-750-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071003076
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071003076
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: