Healthcare Provider Details

I. General information

NPI: 1043203649
Provider Name (Legal Business Name): EDMOND FLOOD FEEKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 03/07/2023
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NILES RD STE 4
SAINT JOSEPH MI
49085-3225
US

IV. Provider business mailing address

1090 ARNOLD DR
LITTLE ROCK AFB AR
72099-4933
US

V. Phone/Fax

Practice location:
  • Phone: 269-408-4171
  • Fax: 269-408-4174
Mailing address:
  • Phone: 501-987-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01038158A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number4301504600
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number01038158A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: