=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154420776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL D FELDMAN DO PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8750 SW 144TH ST SUITE 203
-----------------------------------------------------
City | VILLAGE OF PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-7296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-255-0098
-----------------------------------------------------
Fax | 305-255-3466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8750 SW 144TH ST SUITE 203
-----------------------------------------------------
City | VILLAGE OF PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-7296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-255-0098
-----------------------------------------------------
Fax | 305-255-3466
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAEL D FELDMAN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 305-255-0098
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------