Basic Information
| Provider Information | |||||||||
| NPI: | 1790724466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELDMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | BANNER UNIV MEDICAL CENTER | ||||||||
| Address2: | 1501 N. CAMPBELL AVE, ORTHOPAEDIC SURGERY | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857242429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206264024 | ||||||||
| FaxNumber: | 5206262668 | ||||||||
| Practice Location | |||||||||
| Address1: | BANNER UNIV MEDICAL CENTER | ||||||||
| Address2: | 1501 N CAMPBELL AVENUE, ORTHOPAEDIC SURGERY, RM 8401 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857248572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206264024 | ||||||||
| FaxNumber: | 5206262668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 01/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0010X | MD207481 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 207X00000X | 8363 | RI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 20404 | AZ | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04721012 | 05 | MS | MEDICAID | 1780672709 | 01 | ORGANIZATION NPI# | OTHER | 2380842 | 05 | LA | MEDICAID |