MEDICARE: DR. 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	213ES0103X	Foot & Ankle Surgery Podiatrist	5901001043	MI
2	213E00000X	Podiatrist	RF001043	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P41010001	OTHER	MI	MEDICARE PLUS BLUE
9	P41010001	OTHER	MI	MEDICARE ADVANTAGE
13	MI120001	OTHER	MI	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0170034002	OTHER		CIGNA
2	383749866	OTHER	MI	PPOM COFINITY
4	5453041	OTHER	MI	AETNA
5	RF001043	OTHER	MI	BLUE CROSS BLUE SHIELD
6	100763	OTHER	MI	GREAT LAKES HEALTH PLAN
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	480003679	OTHER	MI	RAILROAD
10	RF001043	OTHER	MI	BLUE CARE NETWORK
11	RF001043	OTHER	MI	BLUE CROSS FEP
12	T34138	OTHER	MI	HAP

General Provider Information

NPI Number	:	1629059951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	02/20/2009

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