Basic Information
| Provider Information | |||||||||
| NPI: | 1730138926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIEDE | ||||||||
| FirstName: | ROTEM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 4931 | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601224931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665405303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 SOUTH 54TH STREET | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191431900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157489000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 03/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | MD421881 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1011308350001 | 05 | PA | MEDICAID | 0014579300005 | 05 | PA | MEDICAID | 1629003 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 34928MD421881 | 01 | PA | HEALTH PARTNERS | OTHER | 30019161 | 01 | PA | KEYSTONE MERCY | OTHER |