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General NPI Number Information
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NPI Number | 1497048508
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Entity Type | Organization
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Legal Business Name | FRIEDMAN SPINE AND PAIN CLINIC LTD
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Dates
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Enumeration Date | 05/23/2011
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 5205 CYPRESS CT
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City | LISLE
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State | IL
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Zip | 60532-2007
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Country | US
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Telephone | 312-498-1961
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Fax |
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Provider Business Mailing Address
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Address Line | 5205 CYPRESS CT
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City | LISLE
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State | IL
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Zip | 60532-2007
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Country | US
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Telephone | 312-498-1961
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JARROD DAVID FRIEDMAN
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Credential | M.D.
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Telephone | 312-498-1961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 036118634
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License Number State | IL
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