Provider Demographics
NPI:1558363721
Name:FELTMAN, MICHAEL A (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:FELTMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9301
Mailing Address - Country:US
Mailing Address - Phone:330-666-7256
Mailing Address - Fax:330-666-7256
Practice Address - Street 1:3610 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9301
Practice Address - Country:US
Practice Address - Phone:330-666-7256
Practice Address - Fax:330-666-7256
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002777213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000139142OtherANTHEM
OH0921426Medicaid
OH0688908OtherCIGNA
OH480022327OtherRAILROAD MEDICARE
OHFE0736094Medicare ID - Type Unspecified
OHU41320Medicare UPIN