Provider Demographics
NPI:1700043528
Name:FELTY, BENJAMIN (DPM)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:FELTY
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 1:8301 GOLDEN VALLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4469
Mailing Address - Country:US
Mailing Address - Phone:763-581-5880
Mailing Address - Fax:763-581-5151
Practice Address - Street 1:8301 GOLDEN VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4469
Practice Address - Country:US
Practice Address - Phone:763-581-5880
Practice Address - Fax:763-581-5151
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN878213E00000X
ND59213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10741Medicaid
ND10741Medicaid