Provider Demographics
NPI:1578552287
Name:FELDMAN, MICHAEL IAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:IAN
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 1:30 ASHRIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419
Mailing Address - Country:US
Mailing Address - Phone:937-671-2368
Mailing Address - Fax:
Practice Address - Street 1:30 ASHRIDGE RD.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419
Practice Address - Country:US
Practice Address - Phone:937-671-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036121207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0305459Medicaid
A75536Medicare UPIN
OH0305459Medicaid