Provider Demographics
NPI:1194717991
Name:VIDELA, FELIPE LG (MD)
Entity type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:LG
Last Name:VIDELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 E MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-1302
Mailing Address - Country:US
Mailing Address - Phone:602-788-1521
Mailing Address - Fax:602-688-5420
Practice Address - Street 1:1616 E MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1302
Practice Address - Country:US
Practice Address - Phone:602-788-1521
Practice Address - Fax:602-688-5420
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30207207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0718260OtherBLUE CROSS BLUE SHIELD
AZ7802344OtherAETNA
AZ709438Medicaid
AZ709438Medicaid
AZZ70984Medicare PIN
AZAZ0718260OtherBLUE CROSS BLUE SHIELD
AZ7802344OtherAETNA