Provider Demographics
NPI:1407149263
Name:FELDHAUS, FABIOLA M L (MD)
Entity Type:Individual
Prefix:DR
First Name:FABIOLA
Middle Name:M L
Last Name:FELDHAUS
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:PO BOX 637676
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7676
Mailing Address - Country:US
Mailing Address - Phone:513-528-5600
Mailing Address - Fax:
Practice Address - Street 1:463 OHIO PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3721
Practice Address - Country:US
Practice Address - Phone:513-528-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-120282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074314Medicaid
OH0074314Medicaid