Healthcare Provider Details

I. General information

NPI: 1912101494
Provider Name (Legal Business Name): EITAN FRIEDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STONECREST BLVD SUITE 410
SMYRNA TN
37167-5688
US

IV. Provider business mailing address

300 20TH AVE N STE 403
NASHVILLE TN
37203-2131
US

V. Phone/Fax

Practice location:
  • Phone: 615-220-6144
  • Fax: 615-220-3663
Mailing address:
  • Phone: 615-284-7224
  • Fax: 615-284-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number45269
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number45269
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: