Provider Demographics
NPI:1154420776
Name:MICHAEL D FELDMAN DO PA
Entity type:Organization
Organization Name:MICHAEL D FELDMAN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-255-0098
Mailing Address - Street 1:8750 SW 144TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7296
Mailing Address - Country:US
Mailing Address - Phone:305-255-0098
Mailing Address - Fax:305-255-3466
Practice Address - Street 1:8750 SW 144TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7296
Practice Address - Country:US
Practice Address - Phone:305-255-0098
Practice Address - Fax:305-255-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24321Medicare ID - Type Unspecified