Provider Demographics
NPI:1841386729
Name:FELDMAN, MARIE BROWN (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:BROWN
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:T
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:610 S MAPLE AVE
Mailing Address - Street 2:SUITE 3440
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1091
Mailing Address - Country:US
Mailing Address - Phone:708-524-2121
Mailing Address - Fax:708-524-3199
Practice Address - Street 1:610 S MAPLE AVE
Practice Address - Street 2:SUITE 3440
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1091
Practice Address - Country:US
Practice Address - Phone:708-524-2121
Practice Address - Fax:708-524-3199
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603350OtherBCBS OF IL
IL036061028Medicaid
ILC41735Medicare UPIN
IL686341Medicare ID - Type Unspecified