MEDICARE: RANDY S FELDMAN, DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	5901001043	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	540F337060	OTHER	MI	BCBSM DMERC

General Provider Information

NPI Number	:	1316199276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDY S FELDMAN, DPM

Provider Business Mailing Address
First Line	:	31017 JOHN R RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1907
Country	:	US
Telephone Number	:	248-585-1177
Fax Number	:	248-585-0083

Provider Business Practice Location Address
First Line	:	31017 JOHN R RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1907
Country	:	US
Telephone Number	:	248-585-1177
Fax Number	:	248-585-0083

Authorized Official
Title or Position	:	ASSISTANT
Name	:	KRISTI MARI' MURRAY
Credential	:	M.A.
Telephone Number	:	248-585-1177

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	10/28/2009

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