Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 6494 | IN |
NPI | 1003988940 |
---|---|
Provider Name | Dr. Eugene Michael Feltman |
First Address | South Bend, IN 46617-2839 |
Second Address | South Bend, IN 46617-2839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |