Provider Demographics
NPI:1487673281
Name:FELSTEAD, R KEITH (DO)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:KEITH
Last Name:FELSTEAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N UNION RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5367
Mailing Address - Country:US
Mailing Address - Phone:716-839-8000
Mailing Address - Fax:716-839-8009
Practice Address - Street 1:30 N UNION RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5367
Practice Address - Country:US
Practice Address - Phone:716-839-8000
Practice Address - Fax:716-839-8009
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00052501002OtherBC-BS PROVIDER ID
NY0101782OtherIHA PROVIDER ID
NY00010365802OtherUNIVERA PROVIDER ID
G77500Medicare UPIN
NYDD0902Medicare PIN