Basic Information
| Provider Information | |||||||||
| NPI: | 1417953886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIEDMAN | ||||||||
| FirstName: | IDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1730 SAINT JULIAN PL | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292042410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032566776 | ||||||||
| FaxNumber: | 8032566778 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 E 70TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314054831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125966618 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 524 | SC | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213E00000X | 847 | GA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.