Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 4301055642 | MI |
N | 208000000X | Pediatrician | 4301055642 | MI |
NPI | 1699712174 |
---|---|
Provider Name | Dr. Gerald L. Feldman |
First Address | Troy, MI 48083-1189 |
Second Address | Detroit, MI 48201-2120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 20/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
263022610 | (05) | MI |
700H262280 | BLUE CROSS-BLUE CROSS (01) | |
E77764 | (02) | |
GF055642 | CHAMPUS-CHAMPUS (01) | |
GF055642 | COMMERCIAL-COMMERCIAL NUMBER (01) |