Provider Demographics
NPI:1881688265
Name:FEDER, MARC (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:FEDER
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 1:4211 N CICERO AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1649
Mailing Address - Country:US
Mailing Address - Phone:773-202-8800
Mailing Address - Fax:773-202-8810
Practice Address - Street 1:4211 N CICERO AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1651
Practice Address - Country:US
Practice Address - Phone:773-202-8800
Practice Address - Fax:773-202-8810
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL522170Medicare ID - Type Unspecified
ILT39695Medicare UPIN