=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174726434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK S FRIEDLAND MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 10/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44199 DEQUINDRE RD 623
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48085-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-828-5707
-----------------------------------------------------
Fax | 248-828-5702
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44199 DEQUINDRE RD 623
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48085-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-828-5707
-----------------------------------------------------
Fax | 248-828-5702
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARK FRIEDLAND
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 248-828-5707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | MF064335
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------