Healthcare Provider Details

I. General information

NPI: 1396786844
Provider Name (Legal Business Name): RICHARD M FELDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE EMERGENCY DEPARTMENT
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

505 N LAKE SHORE DR APT 5108
CHICAGO IL
60611-3427
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7054
  • Fax:
Mailing address:
  • Phone: 312-661-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: