Healthcare Provider Details

I. General information

NPI: 1982624086
Provider Name (Legal Business Name): LEONARD G FELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE 3RD FLOOR ADMINISTRATION
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE 3RD FLOOR ADMINISTRATION
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 305-668-5523
  • Fax: 305-665-1576
Mailing address:
  • Phone: 305-668-5523
  • Fax: 305-665-1576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200600108
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number2006-00108
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberME79443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: