MEDICARE: THEODORE J FELTS MD

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	04-26778	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00338240	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	22488110	OTHER	MO	BLUE SHIELD KC, MO

General Provider Information

NPI Number	:	1861436347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE J FELTS MD

Provider Business Mailing Address
First Line	:	7111 W 151ST ST
Second Line	:	#41
City	:	OVERLAND PARK
State	:	KS
Zip	:	66223-2231
Country	:	US
Telephone Number	:	913-413-0016
Fax Number	:	913-413-0017

Provider Business Practice Location Address
First Line	:	16139 FOSTER ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66085-8417
Country	:	US
Telephone Number	:	913-413-0016
Fax Number	:	913-413-0017

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	04/19/2023

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Directions to “ THEODORE J FELTS MD” Practice Location

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