Provider Demographics
NPI:1912979154
Name:FELDMANN, THEODORE BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:BRUCE
Last Name:FELDMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 E CHESTNUT ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5700
Mailing Address - Country:US
Mailing Address - Phone:502-588-4425
Mailing Address - Fax:502-588-4427
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 610
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-588-4450
Practice Address - Fax:502-588-9539
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY237522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200080890Medicaid
KY64237522Medicaid
KY92833OtherTRICARE
KYP00127533Medicare PIN
IN200080890Medicaid
KYC45719Medicare UPIN