Basic Information
Provider Information
NPI: 1376550913
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRIEDLANDER
FirstName: MICHAEL
MiddleName: PHILLIP
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2100 POWELL ST
Address2: STE 900
City: EMERYVILLE
State: CA
PostalCode: 946081826
CountryCode: US
TelephoneNumber: 5103502777
FaxNumber: 5108799130
Practice Location
Address1: 520 W I ST
Address2:  
City: LOS BANOS
State: CA
PostalCode: 936353419
CountryCode: US
TelephoneNumber: 2098260591
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/02/2006
LastUpdateDate: 11/21/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X4301071446MIY Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X4301071446MIN Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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