Healthcare Provider Details

I. General information

NPI: 1649434036
Provider Name (Legal Business Name): TIMOTHY JOHN FRIEDRICH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19552 S HARLEM AVE
FRANKFORT IL
60423-6733
US

IV. Provider business mailing address

250 S NORTHWEST HWY STE 200
PARK RIDGE IL
60068-4252
US

V. Phone/Fax

Practice location:
  • Phone: 815-928-8050
  • Fax: 815-928-8932
Mailing address:
  • Phone: 847-324-3976
  • Fax: 847-929-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016-005440
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: