Provider Demographics
NPI:1790724466
Name:FELDMAN, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
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:BANNER UNIV MEDICAL CENTER
Mailing Address - Street 2:1501 N. CAMPBELL AVE, ORTHOPAEDIC SURGERY
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-2429
Mailing Address - Country:US
Mailing Address - Phone:520-626-4024
Mailing Address - Fax:520-626-2668
Practice Address - Street 1:BANNER UNIV MEDICAL CENTER
Practice Address - Street 2:1501 N CAMPBELL AVENUE, ORTHOPAEDIC SURGERY, RM 8401
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-8572
Practice Address - Country:US
Practice Address - Phone:520-626-4024
Practice Address - Fax:520-626-2668
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD207481207RS0010X
RI8363207X00000X
AZ20404207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04721012Medicaid
1780672709OtherORGANIZATION NPI#
LA2380842Medicaid
LA389670YH3UMedicare PIN
RI007003314Medicare PIN
LA2380842Medicaid