Provider Demographics
NPI:1093941072
Name:FELEK, YOSEPH DESTA (DA)
Entity Type:Individual
Prefix:DR
First Name:YOSEPH
Middle Name:DESTA
Last Name:FELEK
Suffix:
Gender:M
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5359 N BROADWAY ST STE C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2586
Mailing Address - Country:US
Mailing Address - Phone:773-293-3812
Mailing Address - Fax:
Practice Address - Street 1:5359 N BROADWAY ST
Practice Address - Street 2:SUITE C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2391
Practice Address - Country:US
Practice Address - Phone:773-293-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000233171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist