Provider Demographics
NPI:1952677353
Name:ONHEALTHCARE LLC
Entity Type:Organization
Organization Name:ONHEALTHCARE LLC
Other - Org Name:ONHEALTHCARE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:FELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-528-1981
Mailing Address - Street 1:100 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 655
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5206
Mailing Address - Country:US
Mailing Address - Phone:248-528-1981
Mailing Address - Fax:248-528-2963
Practice Address - Street 1:8425 WOODFIELD CROSSING BLVD
Practice Address - Street 2:SUITE 136
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-7315
Practice Address - Country:US
Practice Address - Phone:317-554-0555
Practice Address - Fax:248-528-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001039B213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100069211Medicare PIN