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General NPI Number Information
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NPI Number | 1689894867
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Entity Type | Individual
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Provider Name | DUSTIN BLAKE FELDMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 32255 NORTHWESTERN HWY STE 50
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-1572
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Country | US
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Telephone | 947-227-8420
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Fax | 947-227-8421
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Provider Business Mailing Address
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Address Line | 29992 NORTHWESTERN HWY SUITE C
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-3292
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Country | US
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Telephone | 248-851-1430
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Fax | 248-851-5182
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101016881
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 5101016881
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License Number State | MI
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