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General NPI Number Information
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NPI Number | 1689704207
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Entity Type | Individual
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Provider Name | LARRY BRIAN FELDMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8800 BLACKHAWK DR
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City | LAKESIDE
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State | MI
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Zip | 49116-9746
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Country | US
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Telephone | 269-921-0531
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 57
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City | LAKESIDE
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State | MI
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Zip | 49116-0057
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Country | US
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Telephone | 269-921-0531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301081108
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License Number State | MI
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