Provider Demographics
NPI:1992773741
Name:FELDMAN, EDWARD ROTHWELL (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ROTHWELL
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29992 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3292
Mailing Address - Country:US
Mailing Address - Phone:248-851-1430
Mailing Address - Fax:248-851-5192
Practice Address - Street 1:3577 W 13 MILE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-551-2446
Practice Address - Fax:248-551-1094
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2015-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIEF047940207R00000X
MI4301047940207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI191207OtherGREAT LAKES
MI0181374OtherTOTAL HEALTH CARE
MI033257OtherMIDWEST HEALTH PLAN
MI1992773741Medicaid
AZ743205OtherARIZONA FOUNDATION
MIB46265OtherHEALTH ALLIANCE PLAN
MIQMP000003846779OtherMOLINA HEALTHCARE
MI700H273300OtherBLUE SHIELD
MI5452658OtherAETNA
MI7302OtherHEALTH PLAN OF MICHIGAN
MI962488OtherUSA MCO
MIP00910883OtherRAILROAD MEDICARE
MIE06288022Medicare PIN
MI962488OtherUSA MCO
MIMI3936001Medicare PIN
AZ743205OtherARIZONA FOUNDATION
MI0181374OtherTOTAL HEALTH CARE
MI1992773741Medicaid