Provider Demographics
NPI:1366548299
Name:EMIL F.M. FELSKI, D.O., P. A.
Entity type:Organization
Organization Name:EMIL F.M. FELSKI, D.O., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:FM
Authorized Official - Last Name:FELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-677-1234
Mailing Address - Street 1:812 BRIGHTWATER CIR
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4215
Mailing Address - Country:US
Mailing Address - Phone:407-645-2999
Mailing Address - Fax:
Practice Address - Street 1:1120 STATE ROAD 436 STE 1000
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6183
Practice Address - Country:US
Practice Address - Phone:407-677-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS003318207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059873900Medicaid
FLD27335Medicare UPIN
FL81909Medicare ID - Type Unspecified