Basic Information
| Provider Information | |||||||||
| NPI: | 1356557698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIEDMAN | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | LANE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 HAMACHER ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | WATERLOO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189392273 | ||||||||
| FaxNumber: | 6189390245 | ||||||||
| Practice Location | |||||||||
| Address1: | RED BUD REGIONAL CLINIC COMPANY LLC | ||||||||
| Address2: | 509 HAMACHER ST, SUITE 103 | ||||||||
| City: | WATERLOO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189392273 | ||||||||
| FaxNumber: | 6189390245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101016684 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 036-131014 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 5101016684 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | 036-131014 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110E006331 | 01 | MI | BCBS GROUP NUMBER | OTHER |