Healthcare Provider Details

I. General information

NPI: 1114835642
Provider Name (Legal Business Name): JEKAB EZRA FELDMANIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAKE FELDMANIS

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 S BLOOMINGTON ST
GREENCASTLE IN
46135-2113
US

IV. Provider business mailing address

513 S BLOOMINGTON ST
GREENCASTLE IN
46135-2113
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-3600
  • Fax:
Mailing address:
  • Phone: 765-653-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number78715647
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: