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General NPI Number Information
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NPI Number | 1578744918
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Entity Type | Organization
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Legal Business Name | 20TH STREET CLINIC PC
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 105 N 20TH ST
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City | BATTLE CREEK
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State | MI
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Zip | 49015-1746
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Country | US
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Telephone | 269-969-6010
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Fax | 269-964-8422
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Provider Business Mailing Address
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Address Line | 105 N 20TH ST
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City | BATTLE CREEK
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State | MI
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Zip | 49015-1746
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Country | US
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Telephone | 269-969-6010
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Fax | 269-964-8422
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN FEDELE
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Credential | DO
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Telephone | 269-969-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101004673
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License Number State | MI
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