Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 029513 | CT |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 029513 | CT |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 029513 | CT |
NPI | 1689690216 |
---|---|
Provider Name | Dr. Michael J Feltes |
First Address | Springfield, MA 01151-1045 |
Second Address | Mystic, CT 06355-3253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 10/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001295139 | (05) | CT |
B99057 | (02) |