Provider Demographics
NPI:1497736755
Name:FELDMEIER, GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:FELDMEIER
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 1:601 JOHN ST
Mailing Address - Street 2:SUITE N-1100
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-343-4609
Mailing Address - Fax:269-343-8424
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE N-1100
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-343-4609
Practice Address - Fax:269-343-8424
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034047207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2919412Medicaid
MI0C97618OtherBCBSM
MI1648333Medicaid
MI1648333Medicaid
MI0C97618089Medicare PIN
MI0C96220001Medicare ID - Type Unspecified