Provider Demographics
NPI:1073550075
Name:FERNANDEZ-MADRID, FELIX R (MD PHD FACP)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:R
Last Name:FERNANDEZ-MADRID
Suffix:
Gender:M
Credentials:MD PHD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:248-581-5972
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:4160 JOHN R ST STE 917
Practice Address - Street 2:HARPER PROFESSIONAL BLDG
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2017
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-745-0011
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301031283207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630071Medicare PIN