Basic Information
| Provider Information | |||||||||
| NPI: | 1992773741 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELDMAN | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | ROTHWELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29992 NORTHWESTERN HWY | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483343292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488511430 | ||||||||
| FaxNumber: | 2488515192 | ||||||||
| Practice Location | |||||||||
| Address1: | 3577 W 13 MILE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480736710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485512446 | ||||||||
| FaxNumber: | 2485511094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 03/25/2015 | ||||||||
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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 | 207R00000X | EF047940 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | 4301047940 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 191207 | 01 | MI | GREAT LAKES | OTHER | 0181374 | 01 | MI | TOTAL HEALTH CARE | OTHER | 033257 | 01 | MI | MIDWEST HEALTH PLAN | OTHER | 1992773741 | 05 | MI | MEDICAID | 743205 | 01 | AZ | ARIZONA FOUNDATION | OTHER | B46265 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | QMP000003846779 | 01 | MI | MOLINA HEALTHCARE | OTHER | 700H273300 | 01 | MI | BLUE SHIELD | OTHER | 5452658 | 01 | MI | AETNA | OTHER | 7302 | 01 | MI | HEALTH PLAN OF MICHIGAN | OTHER | 962488 | 01 | MI | USA MCO | OTHER | P00910883 | 01 | MI | RAILROAD MEDICARE | OTHER |