Provider Demographics
NPI:1679628820
Name:MICHAEL J. FELTES, DBA SOUND SENIORS GERIATRICS, MD
Entity Type:Organization
Organization Name:MICHAEL J. FELTES, DBA SOUND SENIORS GERIATRICS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MSW
Authorized Official - Phone:860-536-6442
Mailing Address - Street 1:3 HERON RD
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-3253
Mailing Address - Country:US
Mailing Address - Phone:860-536-6442
Mailing Address - Fax:860-536-6442
Practice Address - Street 1:3 HERON RD
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-3253
Practice Address - Country:US
Practice Address - Phone:860-536-6442
Practice Address - Fax:860-536-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004181880Medicaid
CTC01568Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER