Provider Demographics
NPI:1699712174
Name:FELDMAN, GERALD L (MD PHD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:L
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:313-832-9324
Mailing Address - Fax:313-993-8685
Practice Address - Street 1:3950 BEAUBIEN ST FL 3
Practice Address - Street 2:CHILDREN'S HOSPITAL OF MICHIGAN
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2120
Practice Address - Country:US
Practice Address - Phone:313-832-9324
Practice Address - Fax:313-993-8685
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055642207SG0201X, 207SG0202X, 207SG0203X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GF055642OtherCHAMPUS-CHAMPUS
MI263022610Medicaid
GF055642OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262280OtherBLUE CROSS-BLUE CROSS
GF055642OtherCOMMERCIAL-COMMERCIAL NUMBER
GF055642OtherCHAMPUS-CHAMPUS
MI263022610Medicaid