Provider Demographics
NPI:1952310807
Name:FEINMAN, ROSS B (DPM)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:B
Last Name:FEINMAN
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:PO BOX 1355
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-5355
Mailing Address - Country:US
Mailing Address - Phone:248-624-4511
Mailing Address - Fax:248-624-4408
Practice Address - Street 1:620 N PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3448
Practice Address - Country:US
Practice Address - Phone:248-624-4511
Practice Address - Fax:248-624-4408
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRF001959213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5635190OtherBS/BS
MI4350339Medicaid
MI5635190OtherBS/BS
MI6261730001Medicare NSC
MI0N39150Medicare PIN