Provider Demographics
NPI:1063492882
Name:FELIX, IVONNE IVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:IVETTE
Last Name:FELIX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 HUNT CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3686
Mailing Address - Country:US
Mailing Address - Phone:248-299-4345
Mailing Address - Fax:248-299-1288
Practice Address - Street 1:971 HUNT CLUB BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3686
Practice Address - Country:US
Practice Address - Phone:248-299-4345
Practice Address - Fax:248-299-1288
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062904208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4676135Medicaid
MI0N67850004Medicare PIN
MIC79750Medicare UPIN