Provider Demographics
NPI:1215063862
Name:FEINSTAT, THEODOR (MD)
Entity type:Individual
Prefix:
First Name:THEODOR
Middle Name:
Last Name:FEINSTAT
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 1:6555 COYLE AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0303
Mailing Address - Country:US
Mailing Address - Phone:916-965-9650
Mailing Address - Fax:
Practice Address - Street 1:4 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2815
Practice Address - Country:US
Practice Address - Phone:916-773-6200
Practice Address - Fax:916-782-4550
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42319207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13842ZOtherMEDICARE ID - CARMICHAEL
CAZZZ29516ZOtherMEDICARE ID - LINCOLN
CAZZZ43589ZOtherMEDICARE SUBMITTER ID
CAG42319OtherCA MEDICAL LICENSE
CAZZZ13841ZOtherMEDICARE ID - ROSEVILLE
CAG42319OtherCA MEDICAL LICENSE
CAZZZ43589ZOtherMEDICARE SUBMITTER ID