MEDICARE: DR. MICHAEL GRAY FEELY 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	207R00000X	Internal Medicine Physician	23638	NE
2	207RR0500X	Rheumatology Physician	23638	NE

General Provider Information

NPI Number	:	1689794513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL GRAY FEELY M.D.

Provider Business Mailing Address
First Line	:	110 N 175TH ST
Second Line	:	SUITE 2000
City	:	OMAHA
State	:	NE
Zip	:	68118-3582
Country	:	US
Telephone Number	:	402-596-4411
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 N 175TH ST
Second Line	:	SUITE 2000
City	:	OMAHA
State	:	NE
Zip	:	68118-3582
Country	:	US
Telephone Number	:	402-596-4411
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	03/03/2015

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