Provider Demographics
NPI:1023026143
Name:THEODORE S. FEIT, M.D., INC.
Entity Type:Organization
Organization Name:THEODORE S. FEIT, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FEIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-843-7462
Mailing Address - Street 1:2601 W ALAMEDA AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4812
Mailing Address - Country:US
Mailing Address - Phone:818-636-6463
Mailing Address - Fax:818-345-3533
Practice Address - Street 1:2601 W ALAMEDA AVE STE 314
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4812
Practice Address - Country:US
Practice Address - Phone:818-636-6463
Practice Address - Fax:818-345-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G328040Medicaid
CAG32804Medicare ID - Type Unspecified
CA00G328040Medicaid