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General NPI Number Information
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NPI Number | 1699883819
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Entity Type | Organization
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Legal Business Name | S E MICHIGAN FAMILY PRACTICE PC
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 350 E 12 MILE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-2531
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Country | US
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Telephone | 248-399-3550
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Fax | 248-399-6136
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Provider Business Mailing Address
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Address Line | 350 E 12 MILE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-2531
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Country | US
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Telephone | 248-399-3550
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Fax | 248-399-6136
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERWIN E FELDMAN
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Credential | D.O.
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Telephone | 248-399-3550
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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 | EF055658
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License Number State | MI
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