MEDICARE: DR. MICHAEL FELD M.D.

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	2084P0800X	Psychiatry Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31604238	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1427057322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL FELD M.D.

Provider Business Mailing Address
First Line	:	666 DUNDEE RD
Second Line	:	#1302
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2727
Country	:	US
Telephone Number	:	847-400-5806
Fax Number	:	847-400-5825

Provider Business Practice Location Address
First Line	:	666 DUNDEE RD
Second Line	:	#1302
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2727
Country	:	US
Telephone Number	:	847-400-5806
Fax Number	:	847-400-5825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	12/31/2007

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