Provider Demographics
NPI:1760448179
Name:FELDMAN, ALAN L (DO)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:L
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 UNION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2248
Mailing Address - Country:US
Mailing Address - Phone:248-363-4151
Mailing Address - Fax:248-363-9510
Practice Address - Street 1:1965 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-2248
Practice Address - Country:US
Practice Address - Phone:248-363-4151
Practice Address - Fax:248-363-9510
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0856332544OtherBCBS
MI5633254OtherBCN
MI1080543Medicaid
MIE25485Medicare UPIN
MI56332547011Medicare ID - Type Unspecified