Healthcare Provider Details

I. General information

NPI: 1255910402
Provider Name (Legal Business Name): ISAAC FRIEDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 03/29/2024
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S NORTHWEST HWY STE 100
PARK RIDGE IL
60068-4237
US

IV. Provider business mailing address

900 RAND RD STE 300
DES PLAINES IL
60016-2359
US

V. Phone/Fax

Practice location:
  • Phone: 773-631-7898
  • Fax: 773-631-3005
Mailing address:
  • Phone: 847-324-3976
  • Fax: 847-929-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-009813
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: