Provider Demographics
NPI:1467440271
Name:FELDMAN, MITCHELL L (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:L
Last Name:FELDMAN
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 1:1801 N UNIVERSITY DR
Mailing Address - Street 2:#201
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8920
Mailing Address - Country:US
Mailing Address - Phone:954-755-1411
Mailing Address - Fax:957-555-8315
Practice Address - Street 1:1801 N UNIVERSITY DR
Practice Address - Street 2:#201
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8920
Practice Address - Country:US
Practice Address - Phone:954-755-1411
Practice Address - Fax:957-555-8315
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78384207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269024100Medicaid
FL269024100Medicaid
35596Medicare ID - Type Unspecified