Healthcare Provider Details

I. General information

NPI: 1376845529
Provider Name (Legal Business Name): RANDY FELDMAN DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2010
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N MILFORD RD STE. 200
MILFORD MI
48381-1006
US

IV. Provider business mailing address

1501 N MILFORD RD STE. 200
MILFORD MI
48381-1006
US

V. Phone/Fax

Practice location:
  • Phone: 248-676-2080
  • Fax:
Mailing address:
  • Phone: 248-676-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: BRIAN BURKARDT
Title or Position: OWNER/PHYSICAN
Credential: DPM
Phone: 248-676-2080