MEDICARE: DR. AVA RISA FELDMAN D.O.

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	207ND0900X	Dermatopathology Physician	02136	IA
2	207N00000X	Dermatology Physician	02136	IA
3	207ND0101X	MOHS-Micrographic Surgery Physician	02136	IA
4	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	02136	IA
5	207NP0225X	Pediatric Dermatology Physician	02136	IA
6	207NS0135X	Procedural Dermatology Physician	02136	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	070007615	OTHER	IA	MEDICARE RAILROAD

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

General Provider Information

NPI Number	:	1891792958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVA RISA FELDMAN D.O.

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9034
Fax Number	:	920-663-0370

Provider Business Practice Location Address
First Line	:	12327 STRATFORD DR
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-8148
Country	:	US
Telephone Number	:	515-224-7088
Fax Number	:	515-224-9228

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/21/2022

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Directions to “ DR. AVA RISA FELDMAN D.O.” Practice Location

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