Provider Demographics
NPI:1043499338
Name:FELHANDLER, GARY MARK (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MARK
Last Name:FELHANDLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3193
Mailing Address - Country:US
Mailing Address - Phone:734-243-5888
Mailing Address - Fax:734-243-6166
Practice Address - Street 1:1092 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3193
Practice Address - Country:US
Practice Address - Phone:734-243-5888
Practice Address - Fax:734-243-6166
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGM001038213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT34133OtherHEALTH ALLIANCE PLAN
MI1443514Medicaid
MIGF001038OtherSTATE LICENSE NUMBER
MI1443514Medicaid
MIT31433Medicare UPIN