Provider Demographics
NPI:1396878146
Name:FELLER, EDWARD J (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:FELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8353 SW 124TH ST
Mailing Address - Street 2:STE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5851
Mailing Address - Country:US
Mailing Address - Phone:305-259-8720
Mailing Address - Fax:305-259-8725
Practice Address - Street 1:8353 SW 124TH ST
Practice Address - Street 2:STE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-5851
Practice Address - Country:US
Practice Address - Phone:305-259-8720
Practice Address - Fax:305-259-8725
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME19441207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052519700Medicaid
FL91479OtherBCBS
FL052519700Medicaid
FLD59660Medicare UPIN