MEDICARE: CHARLES E FELDT DO

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	207Q00000X	Family Medicine Physician	5101010328	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110F163940	OTHER	MI	BCBSM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427092030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES E FELDT DO

Provider Business Mailing Address
First Line	:	6401 PRAIRIE ST
Second Line	:	SUITE 2300
City	:	MUSKEGON
State	:	MI
Zip	:	49444
Country	:	US
Telephone Number	:	231-727-7944
Fax Number	:	231-724-7812

Provider Business Practice Location Address
First Line	:	6401 PRAIRIE ST
Second Line	:	SUITE 1200
City	:	MUSKEGON
State	:	MI
Zip	:	49444
Country	:	US
Telephone Number	:	231-724-7800
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	05/14/2014

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Directions to “ CHARLES E FELDT DO” Practice Location

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