Provider Demographics
NPI:1053426049
Name:FELDMAN, ERWIN E (DO)
Entity type:Individual
Prefix:DR
First Name:ERWIN
Middle Name:E
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29992 NORTHWESTERN HWY STE C
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3292
Mailing Address - Country:US
Mailing Address - Phone:248-851-1430
Mailing Address - Fax:248-851-5182
Practice Address - Street 1:1385 E 12 MILE RD
Practice Address - Street 2:STE 100
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2602
Practice Address - Country:US
Practice Address - Phone:248-399-6090
Practice Address - Fax:248-399-5282
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEF055658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4989426OtherMEDICARE PTAN
MI0156312614OtherBCBSM
MIEF055658OtherLICENSE
MI0F33895OtherBCBSM
MIE25802OtherHAP
MI124302OtherCARE CHOICE
MI4707017-11Medicaid
MIE25802Medicare UPIN