Provider Demographics
NPI:1003085531
Name:ALAN L FELDMAN DO PC
Entity Type:Organization
Organization Name:ALAN L FELDMAN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-363-4151
Mailing Address - Street 1:1965 UNION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2248
Mailing Address - Country:US
Mailing Address - Phone:248-363-4151
Mailing Address - Fax:248-363-9510
Practice Address - Street 1:1965 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-2248
Practice Address - Country:US
Practice Address - Phone:248-363-4151
Practice Address - Fax:248-363-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0856332544OtherBLUE CROSS BLUE SHIELD
MI111080543Medicaid
MI111080543Medicaid
MI0P54080Medicare PIN