Provider Demographics
NPI:1689643819
Name:FELKEL, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:FELKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 BREVCO PLZ
Mailing Address - Street 2:STE 101
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1382
Mailing Address - Country:US
Mailing Address - Phone:636-561-5437
Mailing Address - Fax:636-561-5100
Practice Address - Street 1:100 BREVCO PLZ
Practice Address - Street 2:STE 101
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1382
Practice Address - Country:US
Practice Address - Phone:636-561-5437
Practice Address - Fax:636-561-5100
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO112703208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200041209Medicaid
MO205066012Medicaid
MO7532130OtherAETNA
MO38972V28462OtherGROUP HEALTH PLAN
MOPC17915OtherCIGNA
MO466094OtherHEALTHLINK
MO1200995OtherUNITED HEALTH CARE
MOH32030OtherMERCY HEALTH PLAN
MOH32030Medicare UPIN