Provider Demographics
NPI:1427092030
Name:FELDT, CHARLES E (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:FELDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 PRAIRIE ST
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444
Mailing Address - Country:US
Mailing Address - Phone:231-727-7944
Mailing Address - Fax:231-724-7812
Practice Address - Street 1:6401 PRAIRIE ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444
Practice Address - Country:US
Practice Address - Phone:231-724-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110F163940OtherBCBSM
MI4829950Medicaid
MIF40059Medicare UPIN
MI0F16394038Medicare ID - Type Unspecified