Provider Demographics
NPI:1295718120
Name:FELLNER, CELESTE K (MD)
Entity type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:K
Last Name:FELLNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32743 23 MILE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2176
Mailing Address - Country:US
Mailing Address - Phone:708-424-3201
Mailing Address - Fax:708-424-5001
Practice Address - Street 1:3035 HAMILTON MASON RD STE 105
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-5545
Practice Address - Country:US
Practice Address - Phone:513-844-8585
Practice Address - Fax:513-844-8769
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002642F213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0795546Medicaid
480025142Medicare PIN
0698420017Medicare NSC
OHT81926Medicare UPIN
OHFE0676541Medicare PIN
OH0676545Medicare PIN
0698420009Medicare NSC