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General NPI Number Information
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NPI Number | 1508045329
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Entity Type | Organization
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Legal Business Name | CHARLES G FELIX LLC
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 5151 S MAIN STREET SUITE D
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City | SYLVANIA
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State | OH
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Zip | 43560-2153
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Country | US
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Telephone | 419-885-8822
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Fax | 419-885-9221
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Provider Business Mailing Address
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Address Line | 5151 S MAIN STREET SUITE D
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City | SYLVANIA
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State | OH
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Zip | 43560-2153
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Country | US
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Telephone | 419-885-8822
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Fax | 419-885-9221
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES G FELIX
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Credential | M.D.
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Telephone | 419-885-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 35082833
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License Number State | OH
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