Provider Demographics
NPI:1548228091
Name:EDWARD J FELLER MD PA
Entity Type:Organization
Organization Name:EDWARD J FELLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-259-8720
Mailing Address - Street 1:8353 SW 124 STREET
Mailing Address - Street 2:SUITE #203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5847
Mailing Address - Country:US
Mailing Address - Phone:305-259-8720
Mailing Address - Fax:305-259-8725
Practice Address - Street 1:8353 SW 124 STREET
Practice Address - Street 2:SUITE #203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-5847
Practice Address - Country:US
Practice Address - Phone:305-259-8720
Practice Address - Fax:305-259-8725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19441207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052519700Medicaid
FL052519700Medicaid
FLK7955Medicare PIN