Provider Demographics
NPI:1073518585
Name:FELTON, JAMES MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:FELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ST LAWRENCE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883
Mailing Address - Country:US
Mailing Address - Phone:419-447-7995
Mailing Address - Fax:419-447-3772
Practice Address - Street 1:27 ST. LAWARENE DR.
Practice Address - Street 2:SUITE 105
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-9290
Practice Address - Country:US
Practice Address - Phone:419-447-7995
Practice Address - Fax:419-447-3772
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2008-08-05
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
OH35041167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0428415Medicaid
OH0480401Medicare ID - Type Unspecified
OHA79534Medicare UPIN